Anatomy of the Ureters

Question 1

Position of the ureters.
Length of ureters.
Parts of the ureters.

Answer 1

Lies behind the peritoneum of the posterior abdominal wall.
10 inches (25 cm).
Divided into two parts: abdominal (5 inches) and pelvic (5 inches)

Question 2

The course of the ureter (Abdominal part).

Answer 2

Renal pelvis → downwards on psoas major → pelvic brim → crosses the end of common iliac or beginning of external iliac artery.

Question 3

The course of the ureter (Pelvic part).

Answer 3

Downwards till the ischial spine → forward of the pelvic floor → base of the urinary bladder.

Question 4

Constrictions of the ureter

Three constrictions along with their position for radiological purposes

Answer 4

1) At the pelvi-ureteric junction → Tip of transverse process of L2
2) At the pelvic brim → in front of sacroiliac joint S1
3) In the wall of the Urinary bladder (ureterovesical junction) → medial to the ischial spine

Question 5

The Lumen of the ureter is usually _____. At the site of constriction, the lumen is ____, so they are usual sites for ________.

Answer 5

The Lumen of the ureter is usually 3 mm. At the site of constriction, the lumen is narrower, so they are usual sites for stone impaction.

Question 6

Posterior and Medial Relations to the abdominal part of the ureter.

Answer 6

Posteriorly:
- Psoas major
- Genito-femoral nerve
- End of common iliac artery
- Beginning of the external Iliac artery

Medially:
- to the right ureter → IVC
- to the left ureter →Inferior mesenteric artery

Question 7

Anterior relations to the abdominal part of the right ureter.

2 intestinal structure and 4 vessels.

Answer 7

2 intestinal structures:
- 3rd part of duodenum
- Ilium with it’s mesentery

4 Vessels:
- Superior mesenteric vessels
- Iliocolic vessels
- Right colic vessels
- Right Gondal vessels

Question 8

Anterior relations to the abdominal part of the left ureter.

1 intestinal structure and 3 vessels

Answer 8

1 intestinal:
- Sigmoid colon with its mesocolon

3 vessels:
- Left gonadal vessels
- Left colic vessels
- Sigmoid vessels

Question 9

Relations of the pelvic part of the ureters

From pelvic brim to ischial spine and ischial spine to urinary bladder

Answer 9

1) From Pelvic brim to Ischial spine
- Posteriorly → internal iliac artery
- Laterally → External iliac artery and ovarian fossa (in females)

2) From the Ischial spine to the Urinary bladder
- In males → crossed by the vas deferens
- In females → crossed by the uterine artery

Question 10

Blood supply to the abdominal part of the ureter.

4 vessels

Answer 10

1) Renal artery and vein
2) Gonadal artery and vein
3) Abdominal aorta
4) Common Iliac artery and vein

Question 11

Blood supply to the pelvic part of the ureter.

Answer 11

1) Superior vesical artery and vein
2) Middle rectal artery and vein
3) Uterine artery and vein (in females)

Question 12

Lymphatic drainage of the ureters

Answer 12

Lateral aortic and common iliac lymph nodes

Question 13

Nerve supply to the ureters.

Answer 13

Parasympathetic:
S2, S3, S4 → Stimulatory to wall → increase peristalsis

Sympathetic:
T11, T12, L1 → Inhibitory to wall → decrease peristalsis

Question 14

Ureteric pain is usually referred to the ____, especially to the ____ (inguinal region) because the skin there is supplied with the ______ nerves.

Answer 14

Ureteric pain is usually referred to the Lower quadrant of the abdomen, especially to the Groin (inguinal region) because the skin there is supplied with the Lower 2 thoracic nerves.