Editing Ureters (section)

== Gross anatomy ==

* In adults, the ureter is 22-30cm in length with a diameter of 1.5-6mm
* Begins posterior to the renal artery and continues along the edge of the psoas muscle
* Situated just lateral to the tips of the transverse processes of the lumbar vertebrae in the retroperitoneum
* '''Segments (3):'''
*# '''Proximal (above the sacrum)'''
*# '''Middle (over the sacrum)'''
*# '''Distal (below the sacrum) segments'''
* '''Normally, 3 constrictions could be identified radiologically in each ureter'''
*# '''Ureteropelvic junction'''
*# '''Where it crosses the iliac vessels'''
*# '''Ureterovesical junction'''
* '''The bifurcation of the common iliac vessels''' to the external and internal illiacs '''is used intraoperatively as a landmark to look for the ureter'''
* '''The genitofemoral nerve runs on top of the psoas major muscle behind the ureter'''
* The right ureter begins behind the descending part of the duodenum
* The left ureter is covered at its origin by the initial part of the jejunum
* '''Proximally, the gonadal vessels are medial to the ureter. The gonadal vessels descend laterally and cross anterior to the ureter, “water under the bridge”''', a third of the way to the bladder.
** '''The gonadal vessels cross the left ureter after running parallel to it for a small distance'''
* As the left ureter approaches the pelvis, it is crossed by the left colic vessels, the sigmoid colon, and its mesocolon
* '''In females, the ureter crosses the infundibulopelvic ligament under the ovarian artery and is just medial to the uterine artery. It also passes through the cardinal ligament and lies in close proximity to the cervix.'''
* '''Medial displacement'''
** '''Of both pelvic ureteral segments might result from (3):'''
**# '''Retroperitoneal fibrosis'''
**# '''Pelvic lipomatosis'''
**# '''Post-abdominoperineal surgery'''.
** And concavity of a single pelvic ureter may result from:
*** Enlarged hypogastric nodes
*** Bladder diverticulum
*** Aneurysmal dilatation of the hypogastric artery
*** May be a normal finding in adult females if only the right ureter is affected because of the uterine tilt to the left.