b.ureters

• Ureters


  • Muscular tube from the hilum of kidney to posterior surface of bladder
  • Enter pelvis CROSSING bifurcation of COMMON ILIAC ARTERIES in front of the sacroiliac joint
  • Runs down lateral wall of pelvis to the region of the ISCHIAL SPINE
  • Turns forward to enter the lateral angle of bladder
• In males


  Ureters crossed by vas deferens
• In females


  Ureters turn forward medially beneath broad ligament crossed by uterine artery
• Right Ureter


  • Anterior relations: duodenum, ileum, R colic and ileocolic vessels, R gonadal vessels
  • Posterior relations: R Psoas, bifurcation of the R common iliac artery
• Left Ureter


  • Anterior relations: Sigmoid colon, L colic vessels, L gonadal vessels
  • Posterior relations: L Psoas, bifurcation of the L common iliac artery
• Ureteric constrictions


  1. Where the renal pelvis joins the ureter

  2. Where it crosses the pelvic brim and external iliac arter

  3. Where it pierces the bladder wall
• Blood supply to ureter

  • Upper - Renal artery
  • Middle - Gonadal artery
  • Lower - Superior vesical artery
• Ureter


  • Retroperitoneal along their entire length
  • 1⁄2 of total length is abdominal and remaining 1⁄2 is pelvic
  • 10 inches /25 cm long
• Ureteric constrictions


  Narrowed at 3 sites - ureteropelvic junction, crossing the external iliac artery and as it is passing through the bladder wall
• Renal stones may lodge

  At the ureteric constriction sites
• Lymph drainage


  • Lateral aortic nodes
  • Iliac nodes
• Ureter nerve supply


  • Renal plexus
  • Testicular / Ovarian plexus
  • Hypogastric plexus
• Afferent fibers travel


  1. With sympathetic nerves

  2. Enter the SC in 1st and 2nd lumbar segments
• Calculus


  Stone that may become lodged at narrow points of the ureter
• Renal colic


  • Severe type of colicky pain
  • Results from distention of a ureter by a calculus
  • Referred over the T 11 through L 2 dermatomes
  • Pain may radiate from the back above the iliac crest, through the inguinal region and into the scrotum or labia majora
• Calculi


  Composed of salts of inorganic or organic acids that may form in the calices of the kidneys, the ureters, or the urinary bladder
• Renal or ureteric colic


  • Severe intermittent pain experienced by patients
  • Caused by a stone that is sharp or > than 3 mm
  • Excessively distending the ureter as it moves down
• Passing of the stone through the ureter


  Usually
• Calculi


  Composed of salts of inorganic or organic acids that may form in the calices of the kidneys, the ureters, or the urinary bladder
• Renal or ureteric colic


  Severe intermittent pain experienced by patients who have a stone that is sharp or > than 3 mm, thereby excessively distending the ureter as it moves down
• Passing of the stone through the ureter


  Usually produces a "loin to groin" (lumbar to inguinal) pain
• Removal of calculi


  1. Via a nephroscope

  2. Via shockwave lithoripsy
• Ureters


  • Carry water
  • Posterior to the Ovarian/Testicular artery
• Common surgical error


  Cut ureter instead of ovarian artery when removing the uterus
• Ureter in relation to:

  • Gonadal vessels - ureter is POSTERIOR
  • Common Iliac vessels - ANTERIOR
  • Internal Iliac vessels - ANTERIOR
  • External Iliac vessels - MEDIAL
• Ureter - Pelvic Course in Males

  1. Enters the pelvis by crossing the bifurcation of the common iliac artery

  2. Runs down the lateral wall of the pelvis in front of the internal iliac artery to the ischial spine

  3. Turns forward to enter the lateral angle of the bladder
• Near its termination


  It is crossed by the vas deferens
• Ureter - Pelvic Course in Females


  1. Crosses over the pelvic inlet in front of the bifurcation of the Common Iliac artery

  2. Runs downward and backward in front of the Internal Iliac artery and behind the ovary

  3. Reaches the Ischial spine, then turns forward and medially beneath the broad ligament

  4. Runs forward lateral to Vagina to enter the bladder
• Ureter


  Crossed by the Uterine Artery
• AT SURGICAL RISK at three pelvic sites

  1. If oophorectomy is performed with hysterectomy, each ureter lies just medial to ovarian vessels within the suspensory ligament of the ovary

  2. Passing inferiorly to the Uterine vessels or in or adjacent to the transverse cervical ligament

  3. In vaginal hysterectomy as they course lateral to the uterine cervix
• Common iliac


  Branches into:
• Branches of common iliac

  • External iliac
  • Internal iliac
• Pelvic vasculature


  • Arranged in such a manner that there is ample collateral circulation
• Common iliac artery


  Bifurcates into two main branches
• Bifurcation of common iliac artery

  1. External iliac artery (which, at the inguinal ligament, becomes the femoral artery)

  2. Internal iliac (hypogastric) artery which descends into the pelvis
• Internal iliac (hypogastric) artery in the pelvis

  Divides into the anterior and posterior branches
• External Iliac Artery


  • Lies on medial border of psoas muscle
  • Gives off inferior epigastric and deep circumflex iliac branches
  • Enters the thigh by passing under inguinal ligament to become femoral artery
• Common Iliac Arteries


  • Right and left common arise at level of L4 lumbar vertebra
  • Run downward and laterally along medial border of psoas muscle
  • Each artery ends in front of sacroiliac joint by dividing into external and internal iliac arteries
  • At the bifurcation, common iliac artery on each side is crossed anteriorly by the ureter
• Internal Iliac Artery


  • Passes down into pelvis in front of sacroiliac joint
  • Supplies pelvic organs
• Kidney lymphatic drainage


  Into left and right lumbar (aortic and caval) lymph nodes