Anatomic Description of the Pelvic Ureter. Modifications in Pathological Conditions

摘要

Iatrogenic ureteral injuries constitute a serious complication of gynaeco-logic surgery. The ureter is most commonly injured at the level of the infundibulopelvic ligament, the uterine artery, and the angles of the vagina. The ureter enters the pelvis over the bifurcation of the iliac vessels at the level of the pelvic brim. A careful inspection through the medial leaf of the broad ligament allows its identification. The caudal portion of the pelvic ureter crosses the upper part of the lateral parametrium and enters the ureteric canal. Inside this canal the ureter conserves a connective sheath that permits a blood-free laparoscopic dissection. Patients affected of ovarian endometriosis or adhesions to the adnexa may present a lateral displacement of the ureter while recto vaginal endometriosis may displace it medially. Intraligamentary myo-mas also distort the retroperitoneal course of the ureter. Laparoscopic approach is an excellent tool to improve the knowledge of the ureteral anatomy and the variations of its course in pathological situations.