What is the ureter and what is its function?

The ureter is a narrow, muscular tube about 25 cm long and 3 mm wide. Its primary function is to transport urine from the renal pelvis to the urinary bladder using peristaltic contractions of its smooth muscle layer.

What are the anatomical constrictions of the ureter and why are they important?

The ureter has three key narrowings: the pelviureteric junction at the renal pelvis, the pelvic brim where it crosses the iliac vessels, and the ureterovesical junction where it enters the bladder wall. These are common sites where ureteric calculi (stones) can lodge, causing obstruction and pain.

What is the clinical significance of renal colic related to the ureter?

Renal colic is severe spasmodic pain caused by stone impaction in the ureter. The pain typically radiates from the flank to the groin, scrotum, or labium, following the T12–L2 dermatomes that correspond to the ureter's nerve supply.

How is the ureter divided anatomically and what are its key relations?

The ureter is divided into an abdominal part (from renal pelvis to pelvic brim) and a pelvic part (from pelvic brim to bladder base). Key relations include the psoas major posteriorly, crossing the common iliac artery at the pelvic brim, and being crossed by the vas deferens in males or uterine artery in females in the pelvis.

What are some congenital anomalies of the ureter?

Common congenital anomalies include double ureter (from early ureteric bud branching), bifid ureter (partial division of the ureteric bud), and retrocaval ureter (abnormal position posterior to the IVC). These develop from variations in the ureteric bud during embryonic development.

What makes the ureter vulnerable during pelvic surgery?

The ureter is vulnerable at specific danger zones during pelvic surgery, including under the uterine artery, at the ovarian fossa, the iliac crossing, and the bladder base. Additionally, stripping the periureteric fascia can damage its arterial plexus, potentially leading to necrosis.

How can surgeons identify the ureter during operations?

Surgeons can identify the ureter by observing its characteristic peristalsis (worm-like motion) and noting its thick muscular wall. These features help distinguish it from nearby blood vessels and other structures.

Ureter – Course, 3 Constrictions & Stone Sites

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