QS Study

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

The right ureter is lateral to the inferior vena cava and the left ureter is lateral to the aorta. It passes posterior to the lower part of the mesentery and terminal ileum near the superior aperture of the pelvic cavity.

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. In the abdomen, the ureter descends on the medial aspect of the psoas major muscle, posterior to the peritoneum. Anterior to the psoas major, it passes in front of the genitofemoral nerve and is crossed by the gonadal vessels.

Relation

(1) Renal pelvis:

  1. In tire renal sinus: Branches of renal vessels lie both infront and behind it.
  2. Outside tire kidney:

Anteriorly :

  1. Renal vessels.
  2. A second part of the duodenum.

Posteriorly: Psoas major muscle.

(2) Abdominal part of the ureter

(a) Anteriorly:

  1. The third part of the duodenum.
  2. The peritoneum.
  3. The right colic vessel.
  4. The ileocolic vessels.
  5. The gonadal vessels.
  6. The root of the mesentery.
  7. The terminal part of the ileum.

(b) Posteriorly:

  1. Psoas major.
  2. The tips of the transverse process.
  3. The genitofemoral nerve.

(c) Medially: Inferior vena cava.

(3) Pelvic part of the ureter:

Pelvic part of the ureter:

In its downward course:

(i) Posteriorly:

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

(ii) Laterally:

  • Fascia covering the obturator intemus.
  • Superior vesical artery.
  • Obturator nerve, artery, and 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 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.

Constrictions

  • At pelviureteral junction.
  • At the brim of the lesser pelvis.
  • At its passage through the bladder wall.
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