Comparison of ureteral and cervical descents during vaginal hysterectomy for uterine prolapse,

Objective: The study measured ureteral and cervical locations during vaginal hysterectomy for prolapse and the extent of parametrial ligament shortening possible. Study Design: Cervical and ureteral position were measured in 26 women undergoing uterine prolapse correction. Parametrial clamp tip location was also measured. Results: The cervix lay between 0 and –14.5 cm (below) the hymen (mean ± SD –5.35 ± 3.96 cm) and the ureters lay +5.0 to –4.0 cm (mean ± SD +1.89 ± 1.99 cm). Correlation of ureteral with cervical position was 0.69 (P< .01) and correlation with ipsilateral uterosacral ligament clamp positions was 0.80 (P< .01). Regression line slope relating cervical descent and cervix to ureter distance was 0.65, indicating that for every 3 cm of cervical descent there was 2 cm widening of the gap between the cervix and ureters and 1 cm descent of the ureter. Conclusion: For every 3 cm of cervical descent the ureters descend 1 cm, thereby widening the ureterocervical gap and permitting ligament shortening during vaginal hysterectomy. (Am J Obstet Gynecol 1998;179:1405-10.)