The uterosacral ligaments are the primary apical supports of the uterus and vaginal vault, connecting the cervix and upper vaginal vault to the sacrum. They form the curved lateral boundaries of the pouch of Douglas (rectovaginal space). Their attenuation produces apical pelvic organ prolapse (uterine prolapse or vaginal vault prolapse after hysterectomy). Uterosacral ligament suspension is the most common native tissue repair for apical prolapse.
| Origin | Posterior cervix and upper vagina |
|---|---|
| Insertion | Anterior sacrum and presacral fascia at S2, S3, S4 |
| Actions | Primary support for the uterine and vaginal vault — resists vault descent; provides level 1 apical support |
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Uterosacral ligament suspension (McCall culdoplasty or vaginal uterosacral suspension) uses the patient's own ligaments to re-support the vaginal apex after hysterectomy, achieving similar long-term outcomes to sacrospinous fixation with different potential complications. The ureter runs adjacent to the uterosacral ligaments and must be identified to avoid ureteral inclusion in the suspension sutures.
Uterine or vault descent from uterosacral ligament attenuation managed with native tissue uterosacral suspension or mesh-based sacrocolpopexy.
