Easy Notes On 【Ureter】Learn in Just 4 Minutes!
Learn everything about: Ureters in situ. Course and relations The right ureter is lateral to the inferior vena cava and the left ureter is lateral to the aorta. The relations of the ureter are somewhat complex due to the differences between the left and right sides of the abdominal cavity and differences between male. The anterior and posterior relationships of the abdominal part of the ureter are Medially the right ureter is related to inferior vena cava and left ureter is related.
Overlying or somewhat medial to the ischial spine. Injury to Ureter Based on Kenson and Hinman, the ureter could possibly be injured at one of many subsequent 4 dangerous sites: Point where the ureter crosses the iliac vessels.
In the ovarian fossa. Where the ureter is crossed by the uterine artery most dangerous site as damage is likely at this site during hysterectomy. At the base of the bladder. Ureteric Calculus Ureteric calculus probably will stay at 1 of the sites of anatomical narrowings of the ureter especially: At the pelvic ureteric junction.
Where it crosses the pelvic brim. In the intramural part- the narrowest part. Approach to Ureter Throughout its abdominal and upper parts of the pelvic course, the ureter runs deep to the peritoneum and sticks with it closely.
During surgery when the ureter is mobilized, the ureter is in danger of injury for it moves with the peritoneum. Deep to the peritoneum in the abdominal part the ureter is crossed by different blood vessels.
Anatomy, Abdomen and Pelvis, Ureter - StatPearls - NCBI Bookshelf
Because of these vascular Relations an extraperitoneal method of the ureter is favored to that of a transperitoneal method. Development The ureter grows from the ureteric bud appearing as an outgrowth from the mesonephric duct.
Clinical Significance Congenital anomalies: The common congenital anomalies of ureter are: Seldom the additional ureter may open ectopically into the urethra or vagina and cause urinary incontinence. The cause of double pelvis is early division of the ureteric bud near its conclusion, on the other hand the cause of bifid or double ureter is the overly early section of the ureteric bud.
Occasionally during the rise of kidney, the ureter may ascend posterior to the inferior vena cava resulting in postcaval ureter. Structure and Function The ureteric wall is composed of three main of tissue: The lining of the inner layer is transitional epithelium.
Relationship of uterine artery with ureter.
An inner longitudinal and an outer circular layer comprise the smooth muscle layer of the ureter. The ureters have specific anatomic relationships dependent upon which side of the body.
The right ureter lies in close relationship to the ascending colon, cecum, and appendix. The left ureter is close to the descending and sigmoid colon. The abdominal ureter is the segment of the ureter that extends from the renal pelvis to the iliac vessels.
The pelvic ureter extends from the iliac vessels to the bladder . The distal ureter continues from the lower border of the sacrum to the bladder. Embryology The stalk of the ureteric bud which is a diverticulum from the mesonephric duct gives rise to the ureter.
The bud branches near the cranial aspect into the collecting tubules which become confluent and form the major calyces. In the upper or abdominal ureter, the arterial branches stem from the renal and gonadal artery, abdominal aorta, and common iliac arteries. In the pelvic and distal ureter, the arterial branches come from the vesical and uterine arteries, which are branches of the internal iliac artery.
The arterial supply will course along the ureter longitudinally creating a plexus of anastomosing vessels. This is of clinical significance because it allows for safe mobilization of the ureter during surgery when proper exposure from surrounding structures is crucial.
- The Ureters
The venous and lymphatic drainage of the ureter mirrors that of the arterial supply. The lymphatic drainage is to the internal, external, and common iliac nodes . The lymphatic drainage of the left ureter is primarily to the left para-aortic lymph nodes while the drainage of the right ureter primarily drains to the right paracaval and interaortocaval lymph nodes.
Nerves The exact role of the innervation of the ureter is unclear, but the innervation for ureteral peristalsis originates from the intrinsic smooth muscular pacemaker sites.
The aorticorenal, superior, and inferior hypogastric autonomic plexuses give rise to the postganglionic fibers. Physiologic Variants Abnormalities of the ureteric bud give rise to duplications of the abdominal ureter . Abnormal division, specifically incomplete division of the metanephric diverticulum results in a bifid ureter with a divided kidney, while a complete division of the metanephric diverticulum results in a bifid ureter with a double kidney.
In females, the ectopic ureter can open into the vestibule or vagina. This presents as urinary incontinence due to the direct communication between the urinary system and the vagina, causing continuous leakage of urine . Surgical Considerations The most common causes of ureteral injury are iatrogenic . The overall incidence of iatrogenic ureteral injury varies between 0.
Ureteral injuries may present with flank pain, ileus, hematuria, and prolonged high drain outputs. Elevated laboratory levels include BUN and creatinine.
These areas of narrowing poise significant clinical sequelae when dealing with ureteral calculi . The first is the ureteropelvic junction or UPJ. This is the area where the renal pelvis tapers into the proximal ureter. The second region of narrowing occurs where the ureter crosses the iliac vessels. The narrowing is due to the extrinsic compression of the iliac vessels on the ureter and the angle of the ureter as it enters the pelvis.