The ureter as a landmark for robotic sacrocolpopexy

The objective of this study was to report on the location of the ureters in relation to the sacral promontory at the level of the pelvic brim.

Female patients undergoing indicated computed tomographic (CT) urograms were selected for this study. Charts and images from a defined 3-year study period were reviewed. The GE Centricity software was used to evaluate multiplanar CT views and measure the distance from the bilateral ureters to the midpoint of the distal sacral promontory for each subject.

Sixty-three women underwent CT urography during the study period. Of these, 38 met the criteria for inclusion. Among these, the left ureter was 35.9 ± 4.9 mm lateral to the midsacral promontory. The right ureter was 29.7 ± 6.2 mm lateral to the sacral promontory.

On average, the sacral promontory is located 29.7 mm medial to the right ureter at the level of the pelvic brim. This represents a landmark that may prove clinically useful, along with other visual cues, in choosing the proper location for careful dissection toward the anterior longitudinal ligament during robotic sacrocolpopexy.