Introduction to the Ureter

Anatomy

The ureter is a muscular tube extending from the ureteropelvic junction (UPJ) to the bladder for a length of 25-30 cm. The proximal ureter is in the perirenal space, passing posterior to the gonadal vessels and traveling along the psoas muscle to cross over the iliac vessels at the pelvic brim.

The ureters continue inferiorly along the pelvic wall to ~ the level of the ischial spines where they curve anteromedially to enter the bladder. This occurs at the level of the seminal vesicles in men and cervix in women. This anatomic proximity has important implications in women with invasive cervical cancer in whom ureteral obstruction is a common and important complication.

At the ureterovesical junction (UVJ), the ureters pass obliquely through the bladder wall creating a valve effect and therefore preventing reflux. The UVJ, along with the UPJ and pelvic brim, are all physiologic points of narrowing and are often the sites where ureteral stones may be lodged.