Ureters (2nd Lecture) PDF

Presentation title Mirjam Nilsson Dr. Mostafa Mahran Lecturer of Anatomy and Embryology Anatomy department Its all about water  + + Urinary system 301 Fall 2024-2025  Intended learning outcomes 0...

Presentation title Mirjam Nilsson Dr. Mostafa Mahran Lecturer of Anatomy and Embryology Anatomy department Its all about water  + + Urinary system 301 Fall 2024-2025  Intended learning outcomes 01 02 03 Anatomy of ureter Course of ureter Relations of ureter 04 05 06 Constrictions of Blood and nerve Embryology of the ureter supply of ureter ureter  Anatomy of the Ureter Function Muscular tube that conveys urine from kidney and urinary bladder Features: About 25-30 cm long and about 3 mm in diameter Shows 3 constrictions during its whole course The ureter runs nearly half of its course in abdomen and the other half in pelvis  Course of the ureter The abdominal part The renal pelvis divides into 2-3 major calyces each of which divide into a number of minor calyces …each minor calyces receives 1-3 renal papillae (apex of renal pyramids) The renal pelvis runs downwards along medial border of kidney to become continuous with ureter proper opposite lower pole of kidney Papillae Pyramid  The abdominal part The ureter descends with a slight medial inclination on the psoas major directly behind the peritoneum Crosses Infront of end of common iliac artery or beginning of external iliac artery to enter the pelvis  The pelvic part Enters the pelvis by crossing Infront of end of common iliac artery or beginning of external iliac artery Runs on lateral wall of pelvis to level of ischial spine then curves medially to enter the postero- superior angle of urinary bladder Runs an oblique course within the wall of the bladder to open in superolateral wall of trigone Why the oblique course? To prevent back flow or urine into ureter when bladder is distended  Relations of the ureter The ureter is divided into: A) Renal pelvis (RT and LT) B) Ureter proper (RT and LT) C) Pelvic ureter (M and F)  Relations of the ureter Renal pelvis Anterior relations Renal vessels - 2nd part of duodenum (right side) Posterior relation Psoas major  Relations of the ureter Ureter proper Posterior relations (rt and lt) Psoas major Genito femoral nerve Termination of common iliac artery or beginning of external iliac artery Relations of the ureter Ureter proper Anterior relations Rt side 3rd part of duodenum Right colic vessels Testicular or ovarian vessels Ileocolic vessels Root of mesentery (containing terminal ileum)  Relations of the ureter Ureter proper Anterior relations LT side Testicular or ovarian vessels Left colic and sigmoid vessels Sigmoid colon and mesocolon  Medial relations of right and lt ureter RT LT Inferior mesenteric Inferior vena cava vein Internal iliac artery Lumbosacral trunk  Pelvic part of ureter in males Anterior lateral -Obturator internus and its fascia -Obturator nerve -Arteries : Umbilical Obturator inferior vesical Posterior Medial middle rectal Peritoneum Internal iliac artery and vein Lumbosacral trunk  Pelvic part of ureter in males At the base of the bladder Ureter lies Infront of: upper end of seminal vesicle lies behind the→ ductus deferens  Pelvic part of ureter in females Anterior lateral The ovary -Obturator internus and its fascia -Obturator nerve -Arteries : Umbilical Obturator middle rectal Posterior Medial Uterine Internal iliac artery and vein Peritoneum Vaginal Lumbosacral trunk  Arteries and passage of ureter at floor of pelvis Middle rectal A. Ureter runs in the root of the broad ligament Umbilical A. Obturator A. Obturator internus and its fascia Vaginal A. Uterine A.  Constrictions of the ureter 1) At Pelvi-ureteric junction ( where the ureter joins the renal pelvis ) opposite lower end of kidney 2) When the ureter crosses the end of common iliac artery at pelvic brim 3) As it passes inside the bladder wall (intramural part) narrowest part Why is it important to know the Constrictions of the ureter A ureteric calculus may be lodged in any of the 3 parts  Arterial blood supply of ureter 1) Renal artery (supplies renal pelvis) 2) Abdominal aorta 3) Gonadal artery 4) Common iliac artery 5) Internal iliac artery 6) Uterine artery (in females) 7) inferior vesical artery  Nerve supply of ureter Sympathetic and sensory fibers are derived from T10,11,12 and L1 spinal segments Clinical note In ureteric colic , the pain begins in the loin or lumbar region (supplied by T10), and radiate to the groin or inguinal region supplied by (T12 , L1) and to the scrotum or labium majus (L1) Crossing of the ureter to the genitofemoral nerve (L1,2) explains radiation of pain in ureteric colic to the upper part of front of thigh and contraction of cremaster muscle ( in men) Intravenous pyelography  Embryology of the ureter Ureter develops from the ureteric bud which arises from the caudal part of mesonephric duct ( a tube that grows dorsally and cranially to penetrate the metanephric cap Upper end of ureter divides repeatedly to form a) Pelvis of ureter b) Major and minor calyces c) Collecting tubules of kidney As a result of absorption of caudal segment of mesonephric duct into the posterior wall of urogenital sinus , the ureter comes to open into bladder two fusiform dilatations appear in the lumen ( one in the abdominal part while other in pelvic part , as a consequence 3 relative constrictions appear at the ends of these dilatations  Anomalies of the ureter Double ureter Ectopic ureter Bifid ureter +  Anomalies of the ureter 1. Double ureter : this is due to presence of 2 ureters on one side , it is due to early splitting of ureteric bud into 2 parts each have its own metanephric cap 2. Ectopic ureter : in case of double ureter , where one opens into the bladder and other opens into the vagina or urethra 3.Bifid ureter or cleft renal pelvis : due to late splitting of the ureteric bud , resulting in division of the upper part of ureter