Ureteral disease

Ureter
Ureter (Anatomical View)
Ureter (Schematic View)
1. Human urinary system: 2. Kidney, 3. Renal pelvis, 4. Ureter, 5. Urinary bladder, 6. Urethra. (Left side with frontal section), 7. Adrenal gland

Vessels:
8. Renal artery and vein, 9. Inferior vena cava, 10. Abdominal aorta, 11. Common iliac artery and vein
With transparency:
12. Liver, 13. Large intestine, 14. Pelvis

Latin Ureter
Gray's subject #254 1225
Artery Superior vesical artery, Vaginal artery, Ureteral branches of renal artery
Precursor Ureteric bud
MeSH Ureter
Dorlands/Elsevier Ureter

In human anatomy, the ureters are tubes made of smooth muscle fibers that propel urine from the kidneys to the urinary bladder. In the adult, the ureters are usually 25–30 cm (10–12 in) long and ~3–4 mm in diameter. Histologically, the ureter contains transitional epithelium and an additional smooth muscle layer in the more distal one-third to assist with peristalsis.

In humans, the ureters arise from the renal pelvis on the medial aspect of each kidney before descending towards the bladder on the front of the psoas major muscle. The ureters cross the pelvic brim near the bifurcation of the iliac arteries (which they cross anteriorly). This is a common site for the impaction of kidney stones (the others being the ureterovesical valve, where the ureter meets the bladder, and the pelvouteric junction, where the renal pelvis meets the ureter in the renal hilum). The ureters run posteroinferiorly on the lateral walls of the pelvis and then curve anteriormedially to enter the bladder through the back, at the vesicoureteric junction, running within the wall of the bladder for a few centimetres. The backflow of urine is prevented by valves known as ureterovesical valves.

In females, the ureters pass through the mesometrium and under the uterine arteries on the way to the urinary bladder. An effective phrase for remembering this anatomical relationship is "water (ureters) under the bridge (uterine arteries or vas deferens)."

Ureters are also found in all other amniote species, although different ducts fulfill the same role in amphibians and fish.[1]

The ureters are also known for being extremely hard to work around during surgery and account for 80 percent of failed kidney transplants.

Disorders

Cancer of the ureters is known as ureteral cancer.

A kidney stone can move from the kidney and become lodged inside the ureter, which can block the flow of urine, as well as cause a sharp cramp in the back, side, or lower abdomen.[2] The affected kidney could then develop hydronephrosis, should a part of the kidney become swollen due to blocked flow of urine.[3] There are three sites where a kidney stone will commonly become stuck:

  • at the ureteric junction of renal pelvis;
  • as the ureter passes over the iliac vessels;
  • where the ureter enters into the urinary bladder (vesicoureteric junction).

Clinical

The ureter is sometimes injured during hysterectomies, near the infundibulopelvic (suspensory) ligament or where the ureter courses posterior to the uterine vessels.[4]

Blood Supply

The ureters receive a segmental arterial supply. From proximal to distal the ureter is supplied as follows:

Medially by branches of the following vessels:

  • Renal artery
  • Gonadal artery
  • Abdominal aorta
  • Common iliac artery

Then laterally by branches of:

  • Internal iliac artery and its branches:
  • Superior vesical artery
  • Uterine artery (in women only)
  • Middle rectal artery
  • Vaginal arteries (in women only)
  • Inferior vesical artery (in men only)

Within the periureteral adventitia these arteries extensively anastomose thus permitting surgical mobilization of the ureter without compromising the vascular supply as long as the adventitia is not stripped. Lymphatic and venous drainage mostly parallels that of the arterial supply.[5]

Additional images

References

External links

  • 40:06-0111 - "Posterior Abdominal Wall: Internal Structure of a Kidney"
  • 43:08-02 - "Relationship of the ureter to the uterine artery."
  • 44:02-01 - "Mid-sagittal section of male pelvis."
  • 8923
  • 8945
  • Slide 444
  • Urinary/mammal/ureter/ureter1 - "Mammal, ureter (LM, Medium)"
  • urinary-renal15 - "Ureter"
  • pelvis/pelvis-female-17

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