Ureteral

Ureteral refers to anything relating to the ureter, the paired retroperitoneal tubes that transport urine from the kidneys to the urinary bladder. Each ureter begins at the renal pelvis, descends along the psoas major, and crosses the pelvic brim to join the bladder at the vesicoureteral junction. The ureters are usually described as about 25 to 30 centimeters long in adults and are oriented to facilitate gravity and peristaltic propulsion of urine.

Anatomy and histology: The ureter wall consists of mucosa with transitional epithelium, a submucosa, a muscularis layer, and an outer adventitia. The muscularis typically comprises an inner longitudinal layer and an outer circular layer, coordinating peristaltic waves that move urine toward the bladder. The ureters have three natural constrictions where they are most prone to stone impaction: at the renal pelvis–ureteric junction, where they cross the iliac vessels, and at the vesicoureteral junction with the bladder.

Blood supply and innervation: Arterial supply comes from branches of the renal, gonadal (testicular or ovarian), common iliac, and vesical arteries. Venous drainage parallels the arterial supply, ultimately draining into the renal and iliac venous systems. Autonomic innervation from the renal and pelvic splanchnic nerves modulates ureteral peristalsis and tone.

Clinical relevance: Ureteral function can be disrupted by congenital anomalies, obstruction due to stones or strictures, and iatrogenic injuries during pelvic surgery. Common presentations of obstruction include flank or groin pain and reduced urine flow, potentially with hydronephrosis. Diagnosis may involve CT urography, ultrasound, or radiographic contrast studies. Management ranges from analgesia and hydration to procedures such as ureteroscopy with lithotripsy, stent placement, or surgical reconstruction for persistent obstruction or damage.