2. Ureter anatomy

The ureter connects the renal pelvis to the bladder, typically measuring 20– 30 cm in length. It is a tubular conduit with a smooth muscle structure that confers a capacity for peristalsis. The ureter's course is entirely retroperitoneal; for didactic purposes it is divided into two portions: abdominal and pelvic. The abdominal portion maintains an important relation with the psoas muscle and gonadal vessels, traveling laterally to the latter throughout its abdominal course. Before penetrating the pelvis, uteter passes anteriorly to the iliac vessels, and the pelvic segment initially accompanies the internal iliac artery (Figure 1).

In the female, the pelvic segment of the ureter penetrates the parametrium and courses between the uterine artery (above) and vaginal artery (below). At this

Figure 1. Vascular supply of the uterers and their relation to the great vessels.

more prevalent than the data in the literature would suggest, and may exceed 30% of all surgeries for multicompartmental deep endometriosis, especially when there is intestinal (rectal/sigmoid) infiltration and/or parametrical infiltration. Thus, knowledge of ureteral endometriosis and its management are of fundamental importance for surgeons who propose to perform comprehensive treatment of the

The ureter connects the renal pelvis to the bladder, typically measuring 20– 30 cm in length. It is a tubular conduit with a smooth muscle structure that confers a capacity for peristalsis. The ureter's course is entirely retroperitoneal; for didactic purposes it is divided into two portions: abdominal and pelvic. The abdominal portion maintains an important relation with the psoas muscle and gonadal vessels, traveling laterally to the latter throughout its abdominal course. Before penetrating the pelvis, uteter passes anteriorly to the iliac vessels, and the pelvic segment

In the female, the pelvic segment of the ureter penetrates the parametrium and courses between the uterine artery (above) and vaginal artery (below). At this

various presentations of endometriosis.

Recent Advances in Laparoscopic Surgery

initially accompanies the internal iliac artery (Figure 1).

2. Ureter anatomy

Figure 1.

76

Vascular supply of the uterers and their relation to the great vessels.

point, great care must be taken in its identification, as iatrogenic injuries of the ureter may occur during pelvic surgeries.

The ureter is irrigated by multiple arteries along its course, starting with the renal, gonadal, aorta and common iliac arteries. More distally in its pelvic segment the ureter is supplied by the internal iliac, superior vesicle, uterine, medial rectal arteries, vaginal, and inferior vesicle arteries (Figure 1). As they approach the ureter, the arterial branches travel along a longitudinal pathway within the adventitia (ureteral sheath), forming anastomotic bundles. In this way the surgical dissection of the ureter should strive to preserve the adventitia in order to avoid ischemia.
