Figure 19 22. Photomicrograph of renal medulla with 2 collecting ducts consisting of cuboidal cells resting on a basement membrane.

In this hypertonic region of the kidney, because of the action of the hypophyseal antidiuretic hormone, water is reabsorbed, controlling the water balance of the body

Figure 19 23. Electron micrograph of a collecting tubule wall. M, mitochondria; NU, nucleolus. x15,000.

Ureter The ureters are muscular tubes, 25 30 cm long, that connect the kidneys to the urinary bladder. The ureter are retroperitoneal; their superior halves are in the abdomen (see Chapter 2) and their inferior halves lie in the pelvis. As the ureter cross the bifurcation of the common iliac artery or the beginning of the external iliac artery (Fig. 3.14A) they pass over the pelvic brim, thus leaving the abdomen and entering the lesser pelvis. The pelvic parts of the ureter run on the lateral walls of the pelvis, parallel to the anterior margin of the greater sciatic notch, between the parietal pelvic peritoneum and the internal iliac arteries. Opposite the ischial spine, they curve anteromedially, superior to the levator ani, to enter the urinary bladder. The inferior ends of the ureters are surrounded by the vesical venous plexus (Fig. 3.13B & C). The ureters pass obliquely through the muscular wall of the urinary bladder in an inferomedial direction, entering the outer surface of the bladder approximately 5 cm apart, but their internal openings into the lumen of the empty bladder are separated by only half that distance. This oblique passage through the bladder wall forms a one-way flap valve, the internal pressure of the filling bladder causing the intramural passage to collapse. In addition, contractions of the bladder musculature act as a sphincter preventing the reflux of urine into the ureters when the bladder contracts, increasing internal pressure during micturition. Urine is transported down the ureters by means of peristaltic contractions, a few drops being transported at intervals of 12 20 sec. In males, the only structure that passes between the ureter and the peritoneum is the ductus deferens (Fig. 3.14B); it crosses the ureter within the ureteric fold of peritoneum. The ureter lies posterolateral to the ductus deferens and enters the posterosuperior angle of the bladder, just superior to the seminal gland. In females, the ureter passes medial to the origin of the uterine artery and continues to the level of the ischial spine, where it is crossed superiorly by the uterine artery (see clinical correlation [blue] boxes Iatrogenic Injury of the Ureters during Ligation of Uterine Artery and Iatrogenic Injury of the Ureters during Ligation of Ovarian Artery, in this chapter ). It then passes close to the lateral part of the fornix of the vagina and enters the posterosuperior angle of the bladder.