Autonomic nerve trauma at radical hysterectomy: the nerve content and subtypes within the superficial and deep uterosacral ligaments

The authors previously demonstrated nerve trunks and autonomic ganglia of the hypogastric plexus within the uterosacral ligament (USL) and the cardinal ligaments. The nerve content of these ligaments is greatest closer to the pelvic sidewalls and diminishes toward the insertion of the ligaments into the uterus, with the greater nerve content in the USL. Here the authors determine whether the nerve content of the superficial and deep portion of the USLs, where they are divided at a radical hysterectomy, differ. Biopsies were taken from the right and left superficial and deep USL in 6 patients during radical hysterectomy for early-stage cervical cancer. Indirect immunofluorescence was performed using primary antibodies to (1) the panneuronal marker PGP 9.5, (2) the parasympathetic marker vasoactive intestinal peptide, (3) the sympathetic markers tyrosine hydroxylase and neuropeptide-Y, (4) the sensory and nociceptive nerve marker substance P, and (5) the sensory and sensory-motor nerve marker calcitonin gene-related peptide. The percentage area of immunoreactivity (PAI) was determined using a computer-assisted image analyzer as an objective measure of nerve content. There was a lower nerve content in the superficial USL compared with the deep USL. The PAI of the deep USL was greater than that of the superficial USL for all the nerve markers (P < .05). The PAI was greatest for sympathetic and sensory/nociceptive nerve markers. There were relatively more sympathetic nerve fibers than parasympathetic nerve fibers in the deep USL. These data provide further indirect evidence that pelvic dysfunction following radical hysterectomy is associated with division of the deep portion of the USL.