L2 Ureter Anatomy PDF

# **Renal Module** ## **Course Details:** | **Course Code** | **Phase** | **Year/Semester** | **Duration** | |---|---|---|---| | IMP/07/20318 | I | Second year/semester 3 | 5 weeks | ## **Instructor:** - **Prof. Dr Olfat Anwar Abd El Aty** - **Professor of Anatomy and Embryology** - **Olfata...

# **Renal Module** ## **Course Details:** | **Course Code** | **Phase** | **Year/Semester** | **Duration** | |---|---|---|---| | IMP/07/20318 | I | Second year/semester 3 | 5 weeks | ## **Instructor:** - **Prof. Dr Olfat Anwar Abd El Aty** - **Professor of Anatomy and Embryology** - **[email protected]** ## **Anatomy of the Ureter** - The ureter is a thick-walled, narrow lumen muscular tube that is about 25-30 cm long. - It conveys urine from the kidneys to the urinary bladder. ## **Intended Learning Outcomes (ILOs):** At the end of this lecture, you will be able to: 1. Describe the anatomy of the ureter, regarding its shape, length, and parts. 2. State the location and normal constrictions of the ureter. 3. Differentiate between the relation of the right and left ureters. 4. List the arterial supply of the ureter and its significance. 5. Describe the lymphatic drainage of the ureter. 6. Describe the renal nerve plexus and renal innervations. ## **Parts of the Ureter:** Each ureter has three parts: 1. **Abdominal part:** - The same relations are present in both the right and left ureters: - Medial border of the psoas major and minor muscles. - Tips of the transverse processes of L2, 3, 4, and 5. - Genito-femoral nerve. - Bifurcation of the common iliac artery. - Relations that are different between the right and left ureters: - Right ureter: - The second and third parts of the duodenum. - Three vessels: right colic vessels, right ileocolic vessels, and right gonadal vessels. - Three mesenteric-related structures: root of the mesentery, superior mesenteric vessels, and coils of the small intestine. - Left ureter: - Three vessels: left colic vessels, sigmoid vessels, and left gonadal vessels. - The apex of the sigmoid mesocolon. - Coils of the pelvic colon. - Medial relation: - Right ureter: inferior vena cava - Left ureter: inferior mesenteric vein 2. **Pelvic part:** - It crosses the following structures in both sexes: - The external iliac artery and vein - Obturator nerve - Obturator artery - Obturator vein - In male: the ureter is crossed by the vas deferens. - In female: the ureter passes above the lateral fornix of the vagina. - In female: the relation between the ureter and the ovarian and uterine blood vessels is very important during oophorectomy and hysterectomy. - The ureter may be accidentally ligated with the blood vessels during oophorectomy or hysterectomy, resulting in post-operative renal impairment. 3. **Intramural part:** - The ureters pierce the postero-superior angles of the base of the urinary bladder and run obliquely through its wall for a distance of 1.5-2.0 cm before opening at the ureteric orifices. - This arrangement helps prevent reflux of urine into the ureter when the bladder is full. - Since the intramural ureters are thought to be occluded during increases in bladder pressure at the time of micturition, the intramural part is considered the narrowest part. ## **Constrictions** There are three normal constrictions in the ureter: 1. **At its junction with the renal pelvis, at the tip of the transverse process of L2.** 2. **At the brim of the lesser pelvis, where it crosses the bifurcation of the common iliac artery, at the tip of the sacroiliac joint.** 3. **Where it runs within the wall of the urinary bladder, which is the narrowest part, at the ischial spine.** - The sites of ureteric anatomical constrictions represent the most common site of renal stones impaction. ## **Blood Supply:** 1. **Arterial:** - **Abdominal part:** Supplied by arteries originating medial to the ureter (renal artery, gonadal artery, and branches from the abdominal aorta). - **Pelvic part:** Supplied by vessels originating lateral to the ureter (common iliac, internal iliac, vesical, and uterine arteries). 2. **Venous drainage:** The venous drainage of the ureters generally follows the arterial supply. - There is a lot of variation in the pattern of distribution of the blood to the ureter. - There is good longitudinal anastomosis between the branches along the wall of the ureter. - This means the ureter can be safely transected at any level intra operatively. ## **Lymphatic Drainage:** - **Upper abdominal part:** The collecting lymph vessels join the renal collecting vessels or pass directly to the lateral aortic nodes near the origin of the gonadal artery. - **Lower abdominal part:** Drains to the common iliac nodes. - **Pelvic part:** Drains to the common, external, or internal iliac nodes. ## **Nerve Supply:** - The ureters receive nervous supply via the renal, testicular/ovarian, and hypogastric plexuses. - **Sympathetic plexus:** From nerve cells in T12, L1, and L2 segments. - **Parasympathetic plexus:** From S2, S3, and S4 nerves, which reach the kidney through the pelvic splanchnic nerves. ## **MCQs:** 1. Where does a normal constriction present at the renal pelvis? - At the tip of the transverse process of L2. - At the sacroiliac joint. - At the tip of the ischial spine - At the bifurcation of the common iliac artery 2. What is the medial relation of the abdominal part of the left ureter? - Inferior vena cava. - Inferior mesenteric vein - Left colic vessels - Sigmoid vessels ## **Please contact me if you have any questions.**