Key Anatomy

Question 1

Detail the course of the pelvic ureter?

Answer 1

— enters pelvis ANTERIOR to the bifurcation of the common iliac a.
— descends on the pelvic side-wall MEDIAL to the branches of the internal iliac a. & LATERAL to the ovarian fossa.
—-runs LATERAL to the uterosacral ligaments & SUPERIOR to the cardinal ligament (runs I’m base of broad lig)
—- runs INFERIOR to the uterine a. 1-1.5cm from the isthmus

Question 2

At which points is the ureter at risk of injury during gynaecological surgery?

Answer 2

The ureter is at the greatest risk of injury at 4 points:
1. Pelvic Brim - may be confused with the infundibulopelvic ligament
2. Lateral to ovarian fossa - during ligation of IP ligament
3. Under uterine a. - during ligation of uterine a. during a hyste
4. Where it enters the bladder (anterior to vagina) - adequate reflection of the bladder minimises the risk of distal ureteric injury during total hyste for e.g.

Question 3

What are the types of uterine injury?

Answer 3

2L, 2Ts, ACR

Ligation
Laceration
Transection
Thermal
Angulation (kinking)
Crush (clip application)
Resection