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ANATOMY OF THE PELVIC URETER IN FEMALES

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Author(s): Ch. Zanoschi

Journal: jurnalul de chirurgie (journal of surgery)
ISSN 1584-9341

Volume: 1;
Issue: 1;
Start page: 103;
Date: 2005;
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Keywords: URETER ANATOMY | UTERINE ARTERY | HYSTERECTOMY

ABSTRACT
The ureter is a muscular tube that transmits urine from the renal pelvis to the bladder, a distance of about 25 cm. It runs through the retroperitoneum along the psoas muscle, at the tips of the lumbar transverse processes. It lies on the levator ani muscle before swinging medially into the base of the bladder at the level of the ischial spine. There are three anatomical points of narrowing of the ureter: at the ureteropelvic junction, the site where it crosses the iliac vessels, and at the ureterovesical junction. The pelvic segment of the ureter has three parts: behind the broad ligament, under the broad ligament (near the uterus) and the juxtavesical portion (anterior to the broad ligament). The ureter crosses the pelvic rim at the bifurcation of the common iliac artery (“Luschka’s law”); anterior the ureter is adherent to the peritoneum and it can easily be injured during pelvic and abdominal surgery; it has also external relationship with the lombo-ovarian pedicle and genito-crural nerve. Behind the broad ligament, the ureter comes in relation, on the anterior surface, with the ovary (fosa of Krause and fosa of Claudius), while the posterior surface is in contact with the internal iliac artery. Laterally its relation is with the anterior branches of the internal iliac artery. Under the broad ligament, the pelvic ureter is closely related to the uterine artery. There are two uterine venous plexuses localized anterior and posterior to the ureter. These venous rings explain the movement of the ureter with uterus during the Wiartz’s maneuver. In the juxtavesical portion the ureter is closely related to the vagina and it can be injured during the abdominal or vaginal hysterectomies. D. Alesandrescu describes four important surgical points in the anatomy of the ureter: first, at the superior narrow of the pelvis, were the ureter can be confused with the utero-ovarian pedicle; second, behind the broad ligament, were the ureter is closely attached to the peritoneum and can be sutured during the peritoneal closure; third, under the broad ligament, were the ureter is related to the uterine artery; and fourth, in the juxtavesical portion, due to a close relation with the vagina. The ureter receives blood from the aorta, and from the renal, gonadal, common iliac, vesical, and uterine arteries. The lymphatics drain along each of these vessels. The somatic sensory nerves innervate the ureter in a segmental fashion, which explains why ureteric obstruction can give rise to referred ipsilateral testicular pain.

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