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 cramp 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 uretero-cervical gap and permitting ligament shortening during vaginal hysterectomy.