The ureter Fig 201

The ureter is considered in abdominal, pelvic and intravesical portions.

• Structure: the ureter is approximately 20-30 cm long and courses from the hilum of the kidney to the bladder. It has a muscular wall and is lined by transitional epithelium. At operation it can be recognized by its peristalsis.

• Course: from the renal pelvis at the hilum the course of the ureter can be summarized as follows:

• It passes along the medial part of psoas major behind, but adherent to, the peritoneum.

• It then crosses the common iliac bifurcation anterior to the sacro-iliac joint and courses over the lateral wall of the pelvis to the ischial spine.

• At the ischial spine the ureter passes forwards and medially to enter the bladder obliquely. The intravesical portion of the ureter is approximately 2 cm long and its passage through the bladder wall produces a sphincter-like effect. In the male the ureter is crossed superficially near its termination by the vas deferens. In the female the ureter passes above the lateral fornix of the vagina but below the broad ligament and uterine vessels.

• Blood supply: as the ureter is an abdominal and pelvic structure it receives a blood supply from multiple sources:

• The upper ureter—receives direct branches from the aorta, renal and gonadal arteries.

• The lower ureter—receives branches of the internal iliac and inferior vesical arteries.

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