Ureters

- Two muscular tubes conveying urine from kidneys to the urinary bladder via
peristaltic contractions
- 25- 30 cm long
- Thick-walled and narrow
- They are continuous superiorly with the renal pelvis
- They open into the base of the urinary bladder
- Diameter: approximately 3 mm
- In the abdomen, they lie posteriorly to the peritoneum on the medial part of the
psoas major
R ureter: medial to IVC
L ureter: lateral to aorta
In the male, the pelvic ureter hooks under the vas deferens, passes in front of and
above the upper pole of the seminal vesicle, to traverse the bladder wall obliquely. It
opens at the ipsilateral trigonal angle.
In the female, the pelvic ureter has at first the same relations, then passes behind the
ovary, anterior to the internal iliac artery, forming the posterior boundary of the
ovarian fossa.
- The distal 1-2 cm of the ureter are surrounded by an incomplete collar of nonstriated muscle, called sheath of Waldeyer; it continues into the bladder wall
and is continuous with the superficial trigonal muscle at the ureteric orifices
- The ureters pierce the posterior aspect of the bladder and run through its walls
for 1.5-2 cm
- They end at the ureteric orifices
- Full bladder: the ureteric openings are approximately 5 cm apart
- Empty bladder: the ureteric openings are approximately 2.5 cm apart
Arterial supply
Branches from:
- Renal
- Gonadal
- Common iliac
- Internal iliac
- Vesical: inferior and constant in its course, it supplies the lower part of the
ureter and large part of the bladder trigone
- Uterine
- Abdominal aorta
These vessels form a good longitudinal anastomosis.
The abdominal ureter is supplied by vessels originating medially to it, while the pelvic
ureter is supplied by vessels originating laterally to it.
Venous drainage: it usually follows the arterial supply.
Lymphatics
- Lymphatic drainage begins in the submucosal, intramuscular and adventitial
plexuses (all communicating)
- In the upper abdominal ureter, collecting vessels either join the renal collecting
vessels or drain into lateral aortic nodes near the origin of the gonadal artery
- The vessels of the lower abdominal ureter drain into common iliac nodes
- The vessels of the pelvic ureter drain into the common/internal/external iliac
nodes
Innervation
- The ureter is supplied by the lower three thoracic, I lumbar, II to IV sacral spinal
segments of the spinal cord by branches from the renal and aortic plexuses
- Large bundles of axons (arising from the renal and aortic plexuses, from the
superior hypogastric plexus and nerve and from the hypogastric nerve and the
inferior hypogastric plexus) form an irregular plexus in the adventitia

Interconnecting bundles are commond.The microstructure of the ureters is very similar to that of the calyces and the renal pelvis 1.The impulse propagation happens via myogenic conduction mediated by electrotonic coupling via intercellular gap junctions Microstructure . giving a stellate outline to transverse sections of the lumen. Outer aspect of the ureter: the smooth muscle has a circular/oblique orientation iii. Upper ureter: longitudinal bundles ii. where the smooth muscle is activated and the propagation wave moves away from the kidney . which constitutes a conduit for small blood vessels and bundles of unmyelinated fibers. Middle and lower parts: outer longitudinally oriented fibers (they increase as the uterovesical junction is approached) 3. forming a meshwork of interweaving bundles i.The pacemaker sites are constituted by atypical smooth muscle cells in the walls of the small calyces.- The density of the innervation increases from the renal pelvis/upper ureter to the juxtavesical segment Ureteric peristalsis . The urothelium is usually extensively folded. the deep aspects of the lumen present a layer of subepithelial fibroelastic connective tissue lamina propria. but muscle bundles are separated by large amount of connective tissue. the input passes to the major calyces and then to the renal pelvis.Origin: proximal part of the upper urinary tract. Inner mucosal layer: constituted by urothelium and lamina propria. . External adventitia: the blood vessels and the connective tissue fibers are perpendicular to the long axis of the ureter 2. Smooth muscle layer: it is fairly uniform in thickness. it propagates in anterograde direction towards the bladder .The autonomic innervations plays only a modulatory role .