Editing Urinary tract (section)

== '''Ureter''' ==

* Paired fibromuscular tubes     that convey urine from the kidneys to the bladder

=== '''Embryology''' ===

** Mesodermal origin
** Derived by a process of      budding from the caudal end of the mesonephric duct

=== '''Structure''' ===

** 25cm long
** Narrow points (most common      sites of calculus obstruction): pelviureteric junction, where it crosses      the pelvic brim, and as it passes through the bladder wall
** Whitish, non-pulsatile cord      that vermiculates when gently pinches by forceps

=== '''Sections''' ===

** Abdominal - from renal      pelvis to pelvic brim
** Pelvic - from pelvic brim to      bladder
** Intravesical - within      bladder wall

=== '''Course''' ===

** Retroperitoneal, along      surface of psoas major, in front of tips of transverse processes
** Crosses IN FRONT of      genitofemoral nerve
** Crosses BEHIND the gonadal      vessels, to lie medial to them
** '''Right:''' upper part is protected      behind D3. Lower down crossed anteriorly by right colic and ileocolic      vessels and root of mesentery. Protect it during RHC, even if it's not      visualised, by ensuring gonadal vessels lie posteriorly.
** '''Left:''' lateral to IMA and IMV,      crossed anteriorly by left colic vessels, and by the apex of the sigmoid      mesocolon at the pelvic brim.
** On '''both''' sides, leaves the psoas      muscle at the bifurcation of the common iliac artery, crossing      anteriorly, and passes into the pelvis anterior to SIJ. Course anteriorly      to internal iliac vessels down the lateral pelvic sidewall.
** At the level of the ischial      spine, turn forwards and medially to enter the posterolateral wall of the      bladder, where it runs an oblique 1-2cm course, before opening into the      bladder at the internal ureteric orifice.
*** In men, they are posterior       to the vas.
*** In women, the ureters are       immediately posterior to the ovaries, then cross in the base of the       broad ligaments, where they pass behind and then under the uterine       arteries.
*** Ureters tend to lie       anterior to dissection around the rectum.
** Injuries most commonly occur      near the lower pole of the kidney on the left, or in the pelvis if      anatomy is difficult and distorted

=== '''Relations''' ===

** Abdominal
*** Posterior - psoas,       genitofemoral nerve, tips of L2-L5 TPs, common iliac vessels
*** Anterior left - gonadal       vessels, left colic vessels, sigmoid mesentery and colon
*** Anterior right - descending       duodenum, gonadal vessels, root of mesentery, right colic, ileocolic and       superior mesenteric vessels
** Pelvic
*** Posterior - SIJ, IIA
*** Anterior - vas       deferens/uterine artery
*** Inferior - seminal       vesicle/lateral fornix of vagina

=== '''Surface     markings''' ===

** On anterior abdo wall: from      tip of 9th costal cartilage to the bifurcation of the common iliac artery
** Radiographic course: medial      to tips of the transverse processes of the lumbar vertebrae; crosses      pelvic brim at SIJ; then passes to ischial spine; then to the pubic      tubercle.

=== '''Blood supply''' ===

** Upper end: ureteric branch      of renal artery
** Middle: branches from      abdominal aorta, gonadal, common iliac and internal iliac arteries
** Lower: branches from      inferior and superior vesical and uterine arteries
** All blood vessels anastomose      with each other in ureteric adventitia.

=== '''Lymphatic     drainage''' ===

** Abdominal portion -      para-aortic nodes below the renal arteries
** Pelvic portion - nodes on      the sidewall of the pelvis, alongside the internal iliac arteries

=== '''Innervation''' ===

** SNS - coeliac and      hypogastric plexuses
** PNS - pelvis splanchnic      nerves

=== '''Variant     anatomy''' ===

** Duplex ureter
** Bifid ureter
** Ureterocoele

=== '''Microscopic     anatomy''' ===

** Lined by transitional      epithelium


[[Category:Anatomy]]