ANATOMIE SI TEHNICI CHIRURGICALE - ANATOMY AND
SURGICAL TECHNIQUES
ANATOMY OF THE PELVIC URETER IN FEMALES
Ch. Zanoschi
Institute of Human Anatomy
University of Medicine and Pharmacy „Gr.T. Popa”Iasi
Jurnalul de chirurgie 2005; 1 (1):103-112
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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.
KEYWORDS: URETER ANATOMY, UTERINE ARTERY, HYSTERECTOMY
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