Urinary tract

Question 1

What is the average length of the ureter?

Answer 1

25-30cm

Question 2

What is the relationship of the ureter to the renal artery?

Answer 2

The ureter begins traversing POSTERIORLY to the renal artery

Question 3

What is the relationship of the ureter to the psoas muscle?

Answer 3

The ureter courses along the anterior surface of the psoas muscle

Question 4

What is the relationship of the ureter to the gonadal vessels?

Answer 4

The gonadal vessels cross ANTERIORLY to the ureter from medial to lateral.
They give off branches to supply the ureter.

Question 5

Where does the ureter cross from lateral to medial?

Answer 5

At the level of the sacral promontory
Anterior to the SI joints
Over the bifurcation of the common iliac vessels

Question 6

What are the two most common sites for ureteric injury in gynaecological surgery?

Answer 6

At the level of the

1. infundibulopelvic ligament where the ureters run parallel to the ovarian vessels and the ureter forms the posterior boundary of the ovarian fossa.
2. level of the internal os, about 1.5 cm lateral to the cervix, the uterine artery crosses the ureter from above. This is the point that the ureter is susceptible to injury during abdominal, vaginal, and laparoscopic hysterectomies.
3. Over the anterior vaginal fornix, the ureter turns anteriorly and medially to enter the bladder, within the ureteric tunnel of the cardiac ligament (tunnel of Wertheim) and the intravesical part, where it traverses the musculature of the bladder. At this point, morbidly adherent placenta and repair of lateralization of uterine incision can make the ureter vulnerable to injuries.

Question 7

What is the blood supply to the ureter?

Answer 7

Multiple small unnamed arterial branches of the renal, aorta, gonadal, internal iliac and middle rectal vessels

Question 8

What is the relationship of the blood supply of the ureter, to the ureter, as it descends into the pelvis?

Answer 8

Superior to bifurcation of iliacs - vessels approach the ureter MEDIALLY
Inferior to bifurcation of iliacs - vessels approach the ureter LATERALLY
Clinically important when mobilising the ureter
Approach from other side so not to compromise blood supply

Question 9

What is the average length of the female urethra?

Answer 9

4cm

Its short length predisposes it to urinary infection

Question 10

Course of the ureter.

Answer 10

The ureter begins its descent to the bladder by running along the medial aspect of the psoas muscle. Here, the ureter lies anteriorly and slightly medial to the tips of the L2-L5 transverse processes.

It enters the pelvis anteriorly to the sacroiliac joint at the bifurcation of the common iliac vessels (at the pelvic brim) and then courses anteriorly to the internal iliac artery down the lateral pelvic sidewall.

At the level of the ischial spine it turns forward and medially to enter the posterolateral wall of the bladder, where it runs an oblique 1-2 cm course, before opening into the bladder at the internal ureteric orifice 1,2.