The retropubic space in a nulliparous subject

This view of the retropubic space in a nulliparous woman  is 20 years old.  The posterior surface of the pubis is clear.   The anterior surface of the bladder is clear with the urethra passing beneath the two ligaments and the inferior border of the symphysis pubis

Unusual uterosacral "defect" ?

Another uterosacral defect demonstrating - almost a hernia - in the left uterosacral ligament.  Again a Chinese patient delivered by forceps and presenting with chronic pelvic pain.  The right uterosacral ligament is almost completely intact.

What is your advice to this patient ?

More uterosacral injuries at laparoscopy.  On this occasion a Chinese patient, delivered in Hangzhou - which is interesting because the CS rate is 60-70% and there are correspondlingly few vaginal deliveries. On this occasion there is absent of the left uterosacral ligament that is plastered against the left pelvic side wall.  The right uterosacral ligament is almost intact.  In this patient the features are clearly defined because of the prior procedure to remove the left ovarian endometrioma - by a second year resident.  Peritoneal lavage with normal saline outlines the key anatomical features.