Tuesday, November 6, 2012

ureter anatomy- with illustrations


URETER ANATOMY

Gross Appearance
Length: 25 - 30 cm, in direct relation to the height of the individual.
smooth S curve
Carries urine from renal pelvis to bladder

Dividions
















According to region: Abdominal (above common iliac a. bifurcation) & Pelvic (below)
According to sacroiliac joint: Upper 1/3, Middle 1/3 (bet. Upper & lower sacroiliac j.) & Lower (1/3)

Areas of relative narrowing 

(1) UPJ,
(2) crossing over iliac vessels,
(3) intramural part

Histology

Mucosa: transitional epithelium over lamina propria (loose connective and elastic tissue). 
Musculosa:
Upper part: run helically not arranged in definite layers (considered inner long.& outer circ.)
lower part: longitudinal ms layer. & At UVJ, trigonal ms reflect onto ureter  
Waldeyer’s sheath: reflected trigonal ms onto lower 2-3 com of ureter
thin loose connective tissue at UVJ separate Wldeyer’s sheath from long. ureteric ms
adventitia fibrous connective tissue. Peri-ureteric sheath is thickened coat around ureter from intermediate stratum of retroperitoneum.
Relations : As followed from above downward,
Peritoneal relations
Abdominal ureter: lie within retroperitoneum (intermediate stratum)
Pelvic ureter: covered by the posterior peritoneum; lowermost part is closely attached to it, while the juxtavesical part is embedded in vascular retroperitoneal fat.
Course
lies on the psoas muscles, on transverse process L3,4,5
crosses common iliac artery bifurcation (at pelvic brim)
passes medially to the sacroiliac joints,
swings laterally near the ischial spines
crossed by sup. vesical artery (continue as obliterated umbilical a.) before entering bladder
pass medially to base of the bladder.
Structures that cross over ureter
In both sexes, sup. vesical artery crosses over ureter before it enters bladder
In females, uterine arteries cross over juxtavesical part of the ureters.

In males, vas crosses anterior to the ureters over the lateral pelvic walls (after it leave the internal inguinal rings) → lie medial to ureter before joining S.V.

Blood Supply (mostly longitudinal) [ARTEC]
·      abdominal ureter receives arterial branches from a medial direction → dissect laterally
·      pelvic ureter receives arterial branches from a lateral direction → dissect medially

A. Arterial
upper ureters from renal arteries
mid ureter from gonadal arteries.
Lower ureter → aorta (near bifurcation), common iliac, internal iliac (hypogastric), and sup. & inf. vesical arteries + uterine a. (in females).
B. Venous
The veins are paired with the arteries.

Nerve Supply 
















(autonomic) (unclear role)

From Inf. Mesenteric, testicular & pelvic plexus which receive:
Ø  Sympathetic from T11 – L2
Ø  Parasympathetic from S2 –S4
Pacemaker of ureteric prestalsis lies in renal pelvis, however, main stimulus for peristalsis is urine bolus

Lymphatic drainage
accompany bl.supply
upper ureter: Lumbar L.N. (Rt → interaortocaval, precaval & Lt → paraaortic),
middle ureter common iliac L.N.s
lower urete vesical, internal iliac & ext. iliac L.N.s 

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