L2 Anatomy of the Ureter (P1 Mid)

Quranic Verse

• A verse from Surah Adh-Dhariyat, verse 21, is quoted.
• The English translation of the verse is provided.

Renal Module

• Course code: IMP/07/20318
• Phase I
• Second year/semester 3
• Course duration: 5 weeks

Anatomy and Embryology Professor

• Professor Olfat Anwar Abd El Aty
• Email: [email protected]

Anatomy of the Ureter

• Length: 25-30 cm
• Thickness: thick-walled, narrow lumen
• Diameter: 3 mm
• Beginning: funnel-shaped renal pelvis within the hilum of the kidney at L1 level.
• Termination: at the postero-superior angles of the base of the urinary bladder.

Intended Learning Outcomes (ILOs)

• Describe the anatomy of the ureter, including shape, length, and parts.
• State the location and normal constrictions of the ureter.
• Differentiate between the relations of the right and left ureters
• List the arterial supply of the ureter and its significance.
• Describe the lymphatic drainage of the ureter.
• Describe the renal nerve plexus and renal innervations.

The Ureters

• Two muscular tubes that convey urine from the kidneys to the urinary bladder.
• Peristaltic contractions move urine.

Course

• Each ureter descends downward behind the peritoneum.
• Opposite the transverse processes of vertebrae L2, 3, 4, and 5.
• In front of the psoas major muscle.
• Enters the pelvis by crossing the bifurcation of the common iliac artery at the sacroiliac joint.
• Passes downwards and backwards along the internal iliac artery.
• Curves medially at the level of the ischial spine to open into the postero-superior angle of the urinary bladder.

Relation of the Psoas Major Muscle

• The relationship between the psoas major muscle and the ureters is crucial for locating the ureters in computed tomography (CT) scans.

Parts of the Ureter

• Abdominal part
• Pelvic part
• Intramural part

1-The Abdominal Part of the Ureter

• Medial border of the psoas major and minor muscles
• Tips of the transverse processes of vertebrae L2, 3, 4, and 5
• Genito-femoral nerve
• Bifurcation of the common iliac artery.
• Two/three parts of the duodenum
• Three vessels (Right Colic, Ileocolic, and Right Gonadal vessels)
• Three mesenteric related structures (Root of the mesentery, Superior mesenteric vessels, and coils of the small intestine)
• Three vessels (Left Colic, Sigmoidal, and Left Gonadal vessels)
• Apex of the sigmoid mesocolon
• Medial relation (Inferior vena cava, Inferior mesenteric vein, Left colic vessels, and Sigmoidal vessels).

2- Pelvic Part of the Ureter

• Relations: external iliac artery and vein, obturator nerve, obturator artery, and obturator vein.
• Male: ureters crossed by vas deferens.
• Female: ureters pass above the lateral fornix of the vagina.

Female Relation and Removal of Organs

• The relationship between the ureter and ovarian/uterine blood vessels during oophorectomy and hysterectomy is important.
• Ligation of organs' blood supply during organ removal.
• Potential for ureteral injury.
• Immediate surgical intervention may be necessary.

3- Intramural Part of the Ureter

• The ureters pierce the postero-superior angles of the base of the urinary bladder.
• Run obliquely through the bladder wall.
• Opening: ureteric orifices.
• Length: 1.5-2.0 cm within the bladder wall.
• Prevention of urine reflux into the ureter when the bladder is full.
• Intramural ureters thought to be occluded during bladder pressure increases.

Normal Ureter Constrictions

• Three constrictions along the ureter's course.
• First: where the ureter joins the renal pelvis (at the tip of the transverse process of L2).
• Second: at the brim of the lesser pelvis (where it crosses the bifurcation of the common iliac artery).
• Third: within the urinary bladder wall (at the ischial spine).
• These sites are a common location for renal stones.

MCQs

• Multiple-choice questions on ureter anatomy and location.
• Presented as examples for students.

Arterial Blood Supply of the Ureter

• Abdominal part: supplied by arteries medial to the ureter (renal artery, gonadal artery, branches of the abdominal aorta).
• Pelvic part: supplied by vessels lateral to the ureter (common iliac, internal iliac, vesicle and uterine arteries.)
• Venous drainage generally follows the arterial supply.
• Anastomosis (connection) exists between arterial branches.
• Safe transection (cutting) is possible because of the arterial connections.

Lymphatic Drainage of the Ureter

• Upper abdominal part: collecting lymph vessels join the renal or lateral aortic nodes near the gonadal artery
• Lower abdominal part: common iliac nodes
• Pelvic part: common, external, or internal iliac nodes.

Nerve Supply to the Ureters

• Supplied via the renal, testicular/ovarian, and hypogastric plexuses.
• Sympathetic plexus: nerve cells lie in T12, L1, L2 spinal segments.
• Parasympathetic plexus: S2, S3, S4 spinal segments.
• Nerves reach the kidneys through the pelvic splanchnic nerves.

Contact Information

• Contact information is provided for assistance.

Thank You

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This quiz covers the anatomy of the ureter, focusing on its shape, length, and significance. It includes the location, normal constrictions, and arterial supply of the ureter. Test your understanding of the anatomical features and associated learning outcomes for the renal module.