L2 Anatomy of the Ureter (P1 Mid)

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Questions and Answers

What is a consequence of accidental ligation of the ureter during oophorectomy or hysterectomy?

Reduction in renal stones

Post-operative renal impairment (correct)

Enhanced bladder function

Increased urinary flow

Where does the ureter become the narrowest part?

At the ischial spine (correct)

At the tip of the transverse process of L2

At the bifurcation of the common iliac artery

At the renal pelvis junction

Which structure supplies the abdominal part of the ureter with arterial blood?

Internal iliac artery

Uterine artery

Common iliac artery

Gonadal artery (correct)

What is the primary function of the intramural portion of the ureter?

Prevent reflux of urine Signup and view all the answers

What is the approximate length of the ureter?

25-30 cm Signup and view all the answers

What is the primary draining lymph node for the lower abdominal part of the ureter?

Common iliac nodes Signup and view all the answers

Which of the following correctly describes the nerve supply to the ureters?

Renal and hypogastric plexuses Signup and view all the answers

Which of the following best describes the abdominal part of the ureter's relations?

It has different relations in both right and left ureters. Signup and view all the answers

Which artery is NOT associated with the right ureter?

Left colic artery Signup and view all the answers

What is a key characteristic of the blood supply in the ureters?

Good longitudinal anastomosis Signup and view all the answers

What structure does the ureter NOT cross in the pelvic part?

Ovarian artery Signup and view all the answers

At which point does the ureter cross the bifurcation of the common iliac artery?

At the tip of the sacroiliac joint Signup and view all the answers

What key difference is noted between the ureters in males and females?

The ureter crosses the vas deferens in males. Signup and view all the answers

Which of the following signifies an important relation of the ureter during surgical procedures in females?

Ovarian and uterine blood vessels Signup and view all the answers

Which nerve is associated with the relations of both the right and left ureters?

Genito-femoral nerve Signup and view all the answers

What is the significance of understanding the arterial supply of the ureter?

It helps during surgical interventions involving the ureter. Signup and view all the answers

Study Notes

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.

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Description

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.