1. Anatomy of the Ureter By/ Shimaa Antar Fareed

2. External features  The ureter is a narrow, thick- walled, expansile muscular retroperitoneal tube.  Conveys urine from the kidney to the urinary bladder by the peristaltic contractions of the smooth muscle of its wall. Measurements  Length: 25 -30cm (10 inches).  Diameter: 3-6 mm. Beginning: in front transverse process of L-1 by funnel shape dilatation called renal pelvis Termination: by openings into posterior- superior angle of urinary bladder.

3. The ureter has three parts: Abdominal ureter: from the renal pelvis to the pelvic brim Pelvic ureter: from the pelvic brim to the bladder Intra-vesical or intramural ureter: within the bladder wall 1- Course of the abdominal part of ureter: The ureter begins as a downward continuation of a funnel shaped renal pelvis at the medial margin of the lower end of the kidney. The ureter passes vertically downward behind the peritoneum of posterior abdominal wall on the psoas major, which separates it from the transverse processes of the lumbar vertebrae. Enters the pelvic cavity by crossing in front of the bifurcation of the common iliac artery at the pelvic brim in front of the sacroiliac joint.

4. 1- Posteriorly (Rt & Lt): 1.Psoas major muscle 2. Genitofemoral nerve 3.Common iliac vessels; 4.Tips of L2-L5 transverse processes Relations of the abdominal part

5. 2- Medially:  Right ureter: IVC & lumbar lymph nodes.  Left ureter: IMV ( inferior mesenteric vein)

6. 1- Right ureter: 3 3 rd part of duodenum 3 arteries; 1.Rt gonadal 2.Rt colic 3.Ilio-colic 3 structures related to mesentery; 1.Root of mesentery 2.Superior mesenteric vessels 3.Coils of ilium Anterior relations:

7. Anterior relations of left ureter 3 arteries; 1.Lt gonadal 2.Upper Lt colic 3.Lower Lt colic Sigmoid colon and its mesocolon

9. 2- The pelvic & intramural parts of the ureter Course: Enters the pelvic cavity by crossing in front of the bifurcation of the common iliac artery at the pelvic brim in front of the sacroiliac joint. It run downward along the lower border of internal iliac artery and down on the lateral pelvic sidewall. Male: at the level of the ischial spine it turns forward and medially to enter the posterior wall of the bladder which crosses in front of all the nerves and vessels on the lateral pelvic wall except vas deferens, which crosses in front of it.

10. Female: runs in the base of the broad ligament and crossed by the uterine artery (highly important surgical relationship) to open into postero-superior angle of the bladder. Intra-mural part: it runs very oblique course inside the wall of the bladder for 2 cm before opening; this provide valve like mechanism preventing regurge of the urine into ureter

12. Sites of anatomical narrowing's/constrictions The lumen of the ureter is not uniform throughout and presents three constrictions at the following sites. 1. At the pelvi-ureteric junction where the renal pelvis joins the upper end of ureter. It is the upper most constriction, found approximately 5 cm away from the hilum of kidney. 2. At the pelvic brim where it crosses the common iliac artery. 3. At the uretero-vesical junction (i.e., where ureter enters into the bladder).

13. Arterial supply The ureter derives its arterial supply from the branches of all the arteries related to it. The important arteries supplying ureter from above downward are: 1.Renal. 2.Testicular or ovarian. 3.Direct branches from aorta. 4.Internal iliac. 5.Vesical (superior and inferior). 6.Middle rectal. 7.Uterine.

14. VENOUS DRAINAGE The venous blood from the ureter is drained into the veins corresponding to the arteries. LYMPHATIC DRAINAGE The lymph from the ureter is drained into lateral aortic and iliac nodes.

15. NERVE SUPPLY 1.The sympathetic supply of the ureter is derived from T12–L1 spinal segments through renal, aortic, and hypogastric plexuses. 2.The parasympathetic supply of ureter is derived from S2–S4 spinal segments through pelvic splanchnic nerves.

16. Surface marking of the ureter On the front of the abdomen, the line of the ureter runs from the hilum of the kidney to the pubic tubercle. On the back, from the hilum vertically downward, passing practically through the posterior superior iliac spine.

17. Clinical Correlation Ureteric calculus is likely to lodge at one of the sites of anatomical narrowing of the ureter particularly: (a)At the pelvic ureteric junction. (b)Where it crosses the pelvic brim. (c)In the intramural part—the narrowest part Injury to ureters: According to Kenson and Hinman, the ureter may be injured at one of the following four dangerous sites: (a)Point where the ureter crosses the iliac vessels. (b)In the ovarian fossa. (c)Where the ureter is crossed by the uterine artery (most dangerous site) as damage is likely at this site during hysterectomy. (d)At the base of the bladder.