Ureters

Question 1

what are the ureters?

Answer 1

two thick tubes which act to transport urine from the kidney to the bladder

Question 2

how long are the ureters, how are they situated? function?

Answer 2

They are 25cm long, and are situated bilaterally, with one ureter draining each kidney

Question 3

what do the ureteric walls comprise of? function?

Answer 3

smooth muscle, which contracts to produce peristaltic waves. This propels the urine towards the bladder.

Question 4

where do the ureters arise? as a continuation of what?

Answer 4

in the abdomen as a continuation of the renal pelvis

Question 5

where do the ureters terminate? what do they drain into?

Answer 5

They terminate in the pelvic cavity, where they drain into the bladder

Question 6

what is the anatomical course the ureters are divided into?

Answer 6

the abdominal and pelvic components

Question 7

where do the ureters arise from?

Answer 7

The ureters arise from the renal pelvis

Question 8

what is the renal pelvis? where is it located?

Answer 8

a funnel like structure located within the hilum of the kidney

Question 9

where does the renal pelvis receive urine from?

Answer 9

the major calyces

Question 10

what is the ureteropelvic junction?

Answer 10

The point at which the renal pelvis narrows to form the ureter is known as the ureteropelvic junction

Question 11

after the ureteropelvic junction, what happens to the ureters?

Answer 11

the ureters descend down the abdomen, along the anterior surface of the psoas major.

Question 12

what happens after the ureters travel down the anterior surface of the psoas major?

Answer 12

Here, the ureters are a retroperitoneal structure (located behind the peritoneum)

Question 13

at the area of the sacroiliac joints, what happens to the ureters?

Answer 13

the ureters cross the pelvic brim, thus entering the pelvic cavity

Question 14

what also happens when the ureters enter the pelvic cavity?

Answer 14

they also cross the bifurcation of the common iliac arteries

Question 15

once within the pelvic cavity, what happens to the ureters?

Answer 15

the ureters run down the lateral pelvic walls.

Question 16

when do the ureters turn and which direction? towards what?

Answer 16

At the level of the ischial spines, they turn anteromedially, moving in a transverse plane towards the bladder

Question 17

upon reaching the bladder wall, what happens to the ureters?

Answer 17

the ureters pierce its lateral aspect in an oblique manner

Question 18

what does the ureters piercing the lateral aspect create? what does this prevent?

Answer 18

a one way valve, where high intramural pressure collapses the ureters, preventing the back-flow of urine.

Question 19

why is the anatomical course of the ureters is of surgical importance?

Answer 19

as they travel close to other structures in the pelvis. They must be identified during pelvic surgery to ensure that they are not accidentally damaged.

Question 20

what is the important structures in females that lie in close proximity to the ureters?

Answer 20

As the ureters cross the pelvic brim, they are in close proximity to the ovaries

Question 21

which procedure in females must extra care be taken in?

Answer 21

ovariectomy - care not to damage ureters

especially in ligation of ovarian arteries

Question 22

when do the ureters come in close contact with the uterine artery?

Answer 22

Approximately 2cm superior to the ischial spine, the ureters run underneath the uterine artery

Question 23

in which process is the ureter in danger of accidentally damaged?

Answer 23

During a hysterectomy, where the uterus and uterine artery are removed
relationship between the 2: ‘water under the bridge’

Question 24

which structure lies in close proximity to the ureters in male?

Answer 24

In men, instead of the uterine arteries, the vas deferens cross the ureters anteriorly

Question 25

how can the arterial supply to the ureters be divided?

Answer 25

into abdominal and pelvic supply

Question 26

what is the abdominal supply to the ureters?

Answer 26

renal artery and testicular / ovarian artery

Question 27

what is the pelvic supply to the ureters?

Answer 27

superior and inferior vesical arteries

Question 28

how is venous drainage to the ureters like?

Answer 28

Venous drainage is carried out by vessels that correspond to the abdominal and pelvic arteries (supply)

Question 29

how is nervous supply to the ureters delivered?

Answer 29

delivered via the renal, testicular/ovarian and hypogastric plexuses

Question 30

where do sensory fibres from the ureters enter the spinal cord?

Answer 30

at T11-L2, with ureteric pain referred to those dermatomal areas

Question 31

what is a ureteric calculus (kidney stone)?

Answer 31

the presence of a solid stone in the urinary tract, formed from minerals within the urine

Question 32

what can ureteric calculus cause?

Answer 32

They can obstruct urinary flow, causing pain and haematuria (blood in the urine)

Question 33

what are the locations that the kidney stones are most likely to get stuck in the ureters? why?

Answer 33

There are three locations where the ureters are at their narrowest:

Uretopelvic junction
Pelvic brim
Where the ureter enters the bladder

Question 34

what is the gold standard investigation for suspected ureteric calculus?

Answer 34

CT scan of the kidneys, ureters and bladder (CT-KUB)