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Ureter
Urinary tract la.png
Ureter (Anatomical View)
Urinary system.svg
Ureter (Schematic View)
1. Human urinary system: 2. Kidney, 3. Renal pelvis, 4. Ureter, 5. Urinary bladder, 6. Urethra. (Left side with frontal section), 7. Adrenal gland
Vessels:
8. Renal artery and vein, 9. Inferior vena cava, 10. Abdominal aorta, 11. Common iliac artery and vein
With transparency:
12. Liver, 13. Large intestine, 14. Pelvis
Details
Latin Ureter
Artery Superior vesical artery, Vaginal artery, Ureteral branches of renal artery
Precursor Ureteric bud
Identifiers
Gray's p.1225
MeSH Ureter
Dorlands
/Elsevier
Ureter
Anatomical terminology

In human anatomy, the ureters are tubes made of smooth muscle fibers that propel urine from the kidneys to the urinary bladder. In the adult, the ureters are usually 25–30 cm (10–12 in) long and ~3–4 mm in diameter. Histologically, the ureter contains transitional epithelium and an additional smooth muscle layer in the more distal one-third to assist with peristalsis.

Structure[edit]

In humans, the ureters arise from the pelvis of each kidney, and descend on top of the psoas major muscle to reach the brim of the pelvis. Here, they cross in front of the common iliac arteries. They then pass down along the sides of the pelvis, and finally curve forwards and enter the bladder from its left and right sides at the back of the bladder. [1]:324-326 This is classically depicted as running "posteroinferiorly on the lateral walls of the pelvis and then curve anteriormedially to enter the bladder". The junction between the pelvis of the kidney and the ureters is known as the pelvoureteric junction and the junction between the ureter and the bladder as the vesicoureteric junction. At the entrance to the bladder, the ureters are surrounded by valves known as ureterovesical valves, which prevent the backflow of urine.[citation needed]

In females, the ureters pass through the mesometrium and under the uterine arteries on the way to the urinary bladder. An effective phrase for remembering this anatomical relationship is "water (ureters) under the bridge (uterine arteries or vas deferens).

Blood supply[edit]

The ureters receive a segmental arterial supply, which varies along its course. [1]:324-326

  1. The upper part of the ureter closest to the kidney is supplied by the renal arteries
  2. The middle part of the ureter is supplied by the common iliac arteries, direct branches from the abdominal aorta, and gonadal arteries (the testicular artery in men or ovarian artery in women)
  3. The lower part of the ureter closest to the bladder is supplied by branches from the internal iliac arteries,[1]:324-326, as well as[citation needed]:
  • Superior vesical artery
  • Uterine artery (in women only)
  • Middle rectal artery
  • Vaginal arteries (in women only)
  • Inferior vesical artery (in men only)

Within the periureteral adventitia these arteries extensively anastomose thus permitting surgical mobilization of the ureter without compromising the vascular supply as long as the adventitia is not stripped. Lymphatic and venous drainage mostly parallels that of the arterial supply.[2]

Innervation[edit]

The ureters are richly innervated by nerves that travel alongside the blood vessels. The primary sensation to the ureters is provided by nerves that come from T12-L2 segments of the spinal cord. Thus pain may be referred to the dermatomes of T12-L2, namely the back and sides of the abdomen, the scrotum (males) or labia majora (females) and upper part of the front of the thigh. [1]:324-326

Histology[edit]

The ureter is surrounded by urothelium, a type of transitional epithelium that is capable of responding to stretches in the ureters. The transitional epithelium may appear as a columnar epithelia when relaxed, and squamous epithelia when distended. Below the epithelium, a submucosa exists. The submucosa is made up of connective tissue interspersed with blood vessels, veins and lymphatics. that the ureter is surrounded by two muscular layers, an inner longitudinal layer of muscle, and an outer layer of muscle arranged circularly. [3]:324

In other animals[edit]

Ureters are also found in all other amniote species, although different ducts fulfill the same role in amphibians and fish.[4]

Function[edit]

The ureters are a component of the urinary system. Urine, produced by the kidneys, travels along the ureters to the bladder.

Clinical significance[edit]

Cancer of the ureters is known as ureteral cancer.

The ureters are also known for being extremely hard to work around during surgery and account for 80 percent of failed kidney transplants.[citation needed]

Injury[edit]

The ureter is injured in 0.2 per 1,000 cases of vaginal hysterectomies and 1.3 per 1,000 cases of abdominal hysterectomies,[5] near the infundibulopelvic (suspensory) ligament or where the ureter courses posterior to the uterine vessels.[6]

Kidney stones[edit]

A kidney stone can move from the kidney and become lodged inside the ureter, which can block the flow of urine, as well as cause a sharp cramp in the back, side, or lower abdomen.[7] The affected kidney could then develop hydronephrosis, should a part of the kidney become swollen due to blocked flow of urine.[8] There are three sites where a kidney stone will commonly become stuck:

  • at the ureteric junction of renal pelvis;
  • as the ureter passes over the iliac vessels;
  • where the ureter enters into the urinary bladder (vesicoureteric junction).

Reflux[edit]

Vesicoureteral reflux refers to the reflux of fluid from the bladder to the ureters during urination. This condition can be one cause of chronic urinary tract infections, particularly in children. Vesicoureteral reflux may be treated surgically, and is believed to have a genetic basis.[citation needed]

Additional images[edit]

References[edit]

  1. ^ a b c d Drake, Richard L.; Vogl, Wayne; Tibbitts, Adam W.M. Mitchell; illustrations by Richard; Richardson, Paul (2005). Gray's anatomy for students. Philadelphia: Elsevier/Churchill Livingstone. ISBN 978-0-8089-2306-0. 
  2. ^ Wein, Alan J. (2011). Campbell-Walsh Urology, 10th. ed. Elsevier. p. 31. 
  3. ^ Lowe, Alan Stevens, James S. (2005). Human histology (3rd ed. ed.). Philadelphia, Toronto: Elsevier Mosby. ISBN 0-3230-3663-5. 
  4. ^ Romer, Alfred Sherwood; Parsons, Thomas S. (1977). The Vertebrate Body. Philadelphia, PA: Holt-Saunders International. p. 378. ISBN 0-03-910284-X. 
  5. ^ Burks FN, Santucci RA (June 2014). "Management of iatrogenic ureteral injury". Ther Adv Urol 6 (3): 115–24. doi:10.1177/1756287214526767. PMC 4003841. PMID 24883109. 
  6. ^ Santucci, Richard A. "Ureteral Trauma". Medscape. Retrieved 11 April 2012. 
  7. ^ "Symptoms of Kidney Stones". MedicalBug. 1 January 2012. Retrieved 11 April 2012. 
  8. ^ Resnick, Martin I; Lam, Mildred; Zipp, Thomas (4 September 2009). "Kidney Stones". NetWellness. Retrieved 11 April 2012. 

External links[edit]


Original courtesy of Wikipedia: http://en.wikipedia.org/wiki/Ureter — Please support Wikipedia.
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79 news items

Chicago Sun-Times

Chicago Sun-Times
Mon, 20 Oct 2014 19:20:40 -0700

He had radical surgery to remove his cancerous bladder, prostate and part of his right ureter in July of 2006. He spent 19 days at Loyola University Medical Center and emerged cancer-free. George submitted his letter of resignation in 2012, as all ...
 
Medscape
Tue, 21 Oct 2014 13:48:45 -0700

HONOLULU — The group that recently reported the first live birth after uterus transplantation has announced that two more women are pregnant after undergoing the same procedure. "They are in their 32nd week of pregnancy," Mats Brännström, MD, from the ...
 
New York Times (blog)
Mon, 20 Oct 2014 18:12:27 -0700

Bladder and ureter damage accounted for most of the increased number of injuries in the robot-assisted operations. The study, published online in Obstetrics & Gynecology, also found that robotic oophorectomy cost an average of $2,504 more than ...
 
OutpatientSurgery.net
Wed, 22 Oct 2014 05:00:00 -0700

The increase of the complications in robotic surgery were mainly bladder and ureter injuries. Additionally, researchers found that during the same time the use of robotic-assisted surgery grew more than 11% between 2009 and 2012 for oophorectomies and ...
 
Nigerian Observer
Wed, 22 Oct 2014 00:15:43 -0700

“In urinary schistosomiasis, there is progressive damage to the bladder, ureter and kidney. “In intestinal schistosomiasis, there is progressive enlargement of the liver and spleen, intestinal damage and hypertension of the abdominal blood vessels ...

New York Times

New York Times
Mon, 13 Oct 2014 03:52:30 -0700

A kidney stone was scraping its way down my right ureter, the narrow tube connecting my right kidney and bladder. Despite my anguish, I was so confident I didn't need a narcotic painkiller that I was willing to put $1,000 on the line. The reason: I ...

ModernMedicine

ModernMedicine
Wed, 15 Oct 2014 17:33:45 -0700

“Same side” includes stones in the kidney, renal pelvis, or ureter regardless of mode of treatment. If the patient's insurance is Medicare, Medicaid, or another federally funded program that uses Medicare rules, you should report only one treatment per ...
 
Royal Gazette
Thu, 09 Oct 2014 04:03:45 -0700

A woman is suing two doctors over claims that they accidentally cut her ureter during a surgery in 2006. Nanette Snowden has launched a legal action against two doctors — Terri-Lynn Emery and Charles Dyer — for “beach of duty of care”, but counsel ...
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