Table 1.
Basic anatomy and histology of apical ligaments
| Feature | Cardinal Ligamenta | Uterosacral Ligamenta |
|---|---|---|
| Origin | • Anterior trunk of internal iliac artery (one-third) | • Cervix alone (33%) |
| • Upper border of greater sciatic foramen (two-thirds) | • Cervix and vagina (63%) | |
| • Vagina alone (4%) | ||
| Insertion | • Cervix and upper third of vagina | • Overlying sacrospinous ligament/coccygeus muscle complex (82%) |
| • Some fibers go to the bladder (one-third) | • Sacrum (7%) | |
| • Piriformis muscle, sciatic foramen, or ischial spine (11%) | ||
| Histology | • Contains uterine vessels, adipose, and inferior hypogastric plexus that conveys autonomic nerves to pelvic organs | • Classical/superficial portion: visible edge beside the cul-de-sac composed of smooth muscle continuous with uterine musculature; appearance can be affected by position, pneumoperitoneum, and anesthesia |
| • Nerves located in intermediate and distal sections | • Deep portion (i.e. rectal pillars/pararectal fascia): likely contains splanchnic nerves and surrounding connective tissue; visible on MRI; extends from sacrum to upper vagina; establishes support of posterior cul-de-sac (point D of POP-Q) | |
a
Data in parentheses indicates proportion of women affected.
POP-Q: pelvic organ prolapse quantification system