Editing Ureters (section)

== Vasculature ==

* Variable arterial supply. '''Most often,'''§
** '''Proximal ureter is supplied medially by branches from the main renal arteries'''
*** Uncommonly, this segment may be supplied by branches arising from the abdominal aorta or gonadal arteries.
** '''Middle ureter is supplied posteriorly by branches from the common iliac arteries''', abdominal aorta, and the gonadal arteries
*** '''CW11 Chapter 33 “The middle ureter is typically supplied by the aorta; however, it may also be supplied by the common iliac, gonadal, uterine, middle rectal, and vaginal arteries”'''
** '''Distal ureter is supplied laterally by the superior and inferior''' (inferior from chapter 33, inferior and uterine from chapter 68) '''vesical arteries, branches of the internal iliac artery'''
*** '''The distal ureteral blood supply is variable.''' '''It is estimated by cadaver studies that 10% of females carry a disproportionate amount of their distal ureteral blood supply via uterine artery branches. These branches are necessarily severed when the uterine artery is ligated during the course of a normal hysterectomy'''.
** '''Therefore, location of endoureterotomy depends on position:'''
*** '''Proximal ureter: (postero)laterally'''
*** '''Mid-ureter: anteriorly'''
*** '''Distal ureter: medially'''
* The ureters should be handled gently to avoid unnecessary lateral retraction; removing excessive periureteral adventitial tissues containing the blood supply can cause ureteral ischemia and subsequent stricture
* Venous drainage:
** Upper ureter: renal and gonadal veins
** Middle and distal ureters: common and internal iliac veins