QS Study

The ureters are a pair of narrow, thick-walled muscular tube which conveys urine from the kidneys to the urinary bladder. It is a tube that carries urine from the kidney to the urinary bladder.

Left Ureter is crossed by the left gonadal and left colic vessels. In the posterior wall of the intersigmoid recess, it runs behind the loops of the jejunum and sigmoid colon and its mesentery.

Course

The ureter begins within the renal sinus as a funnel-shaped dilatation, called the renal pelvis. The pelvis emerges from the hilus of the kidney, descends along its medial margin. Gradually it narrows to become ureter proper.

It passes downwards and medially on the psoas major and enters the pelvis by crossing infront of the termination of the common iliac artery.

In the true pelvis, the ureter at first runs downwards and slightly backward and laterally following the anterior margin of the greater sciatic notch. Opposite, the ischial spine it turns forwards and medially to reach the base of the urinary bladder.

The ureter enters the bladder wall obliquely to open into the lateral angle of its trigone.

Relations

(1) Renal pelvis:

In the renal sinus: Branches of the renal vessels lie both infront and behind it.

Outside the kidney –

(1) Anteriorly: There are renal vessels, the pancreas, the peritoneum, and the jejunum.

(ii) Posteriorly: Psoas major.

(2) Abdominal part of the ureter:

(i) Anteriorly :

  • The peritoneum.
  • The testicular artery.
  • The left colic vessels.
  • The sigmoid colon.
  • The sigmoid mesocolon.

(ii) Posteriorly:

  • The psoas major.
  • The tips of transverse processes.
  • The genitofemoral nerve.

(iii) Medially:

  • The left gonadal vein.
  • The inferior mesenteric vein.

(3) Pelvic part of the ureter:

In its downward course:

(i) Posteriorly:

  • Internal iliac artery.
  • Internal iliac vein.
  • Lumbosacral trunk.
  • Sacroiliac joint.

(ii) Laterally:

  • Fascia covering the obturator intemus.
  • Superior vesical artery.
  • Obturator nerve.
  • Obturator artery.
  • Obturator vein.
  • Inferior vesical vein.
  • Middle rectal artery.
  • In the female, it forms the posterior boundary of the ovarian fossa.

In its forward course:

(i) In males:

  • The ductus deferens crosses the ureter superiorly from lateral to medial side.
  • The seminal vesicle lies below and behind the ureter.
  • The vesical veins surround the terminal part of the ureter.

(ii) In females:

  • The ureter lies in the broad ligament of the uterus.
  • The uterine artery lies first above and infront of the ureter.
  • The ureter lies about 2 cm lateral to the supravaginal portion of the cervix. It runs slightly above the lateral fornix of the vagina.
  • The terminal portion of the ureter lies anterior to the vagina.

(4) Intravesical part: The intravesical oblique course of the ureter has a valvular action.

Constrictions

The ureter is slightly constricted at three places:

  • At the pelvi-ureteral junction,
  • At the brim of the lesser pelvis,
  • At its passage through the bladder wall.
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