Ureters

The ureters are muscular tubes that run from the kidneys to the urinary bladder. They begin at the ureteropelvic junction, where the renal pelvis continues on as the ureter.

Within the abdomen, the ureters descend retroperitoneally and anterior to the muscles of the posterior abdominal wall (psoas major), eventually, they reach the pelvic brim where they enter the pelvis.

Within the pelvis, the ureters continue their descent down the lateral pelvic walls. The ureters eventually pierce the urinary bladder and define the upper limit of the urinary bladder’s trigone area.

The ureters are normally constricted at three sites, where kidney stones most commonly cause obstruction:

1. At the ureteropelvic junction

2. Where the ureters cross the pelvic inlet

3. At the ureterovesical junction

Blood Supply:

The arteries supplying the ureter are derived from the abdominal aorta, renal artery, testicular artery, ovarian artery, common iliac artery, internal iliac artery, inferior vesical artery, and uterine artery. Branches from these arteries supply different parts of the ureter along its course.

The most constant arterial supply of the lower part of the ureter is the uterine artery in the female and the inferior vesical artery in the male.

Venous Drainage:

The veins draining the ureter follow the arterial supply.

Innervation:

The ureter is innervated by the ureteric plexus.

The ureteric plexus contains both parasympathetic and sympathetic components, although they do not play a major role in ureteral peristalsis.

Clinical Notes:

1. Ureteric pain from kidney stones may be referred to the T11 to T12 dermatome (loin to groin).