ANATOMY

Human ureters originate from the Renal Pelvis (funnel like dilated part of ureter in kidney) on the medial of each Kidney before going down towards the Urinary Bladder on the front side of Psoas Major muscle (spindle shaped muscle at brim of lesser Pelvis). Near the common Iliac arteries Ureters cross the Pelvic Brim (edge of the Pelvic Inlet which is the boundary between the Abdominal and Pelvic Cavity). This region is the common impact point for Kidney Stones. To enter the bladder through back at Vesicoureteric Junction (VUJ) Ureters go posteriorly on the lateral walls of Pelvis and take a curve anteriorly. Ureterovesical Valves prevent the backflow of urine.

The female Ureters on their way to Urinary bladder pass through Mesometrium (Mesentry of Uterus) and below the Uterine Arteries. To memorize this anatomy an effective phrase is used i.e. Water (Ureters) Under the Bridge (Uterine Arteries).

BLOOD SUPPLY

The blood supply to Ureters is given through Segmental Arterial Supply. From start to end Ureters is supplied as follows.

Medially it is supplied by following vessels.

• Renal Artery

• Gonadal Artery

• Abdominal Aorta

• Common Iliac Artery

Laterally it is supplied by following vessels.

• Internal Iliac Artery and its branches

• Superior Vesical Artery

• Uterine Artery (in women only)

• Middle Rectal Artery

• Vaginal Arteries  (in women only)

• Inferior Vesical Arteries (in men only)

These arteries are linked within the Periureteral Adventitia thus allowing surgical mobility without destroying the vascular supply for as long as the link is not compromised. Lymphatic and venous drainage are mostly parallel to the arterial supply.

CLINICAL SIGNIFICANCE

Cancer of the Ureters is called Ureteral Cancer. A kidney stone can block the Ureter while coming from Kidney resulting in the blockage of urine and also result sharp cramp in the back. The three states in which a kidney stone may stuck which are as follows.

• At ureteric junction of Renal Pelvis

• At ureter passing over the Iliac Vessels

• At the point where Ureter enters in Urinary bladder

Ureter is also sometimes damaged during the Hysterctomy (surgical removal of Ureter) or the region where the Ureter passes posterior to Uterine Vessels. Ureters account for 80% of failed kidney transplant.