Ureter- Ureteric Stones-Renal Colic-Traumatic Ureteral Injuries

Ureter

Each ureter measures about 10 in. (25 cm) long,having three constrictions along its course where the renal pelvis joins the ureter, where it is kinked as it crosses the pelvic brim, and where it pierces the bladder wall


Ureteric Stones

There are three sites of anatomic narrowing of the ureter where stones may be arrested, namely, the pelviureteral junction, the pelvic brim, and where the ureter enters the bladder. Most stones, although radiopaque, are small enough to be impossible to see definitely along the course of the ureter on plain radiographic examination. An intravenous pyelogram is usually necessary. The ureter runs down in front of the tips of the transverse processes of the lumbar vertebrae, crosses the region of the sacroiliac joint, swings out to the ischial spine, and then turns medially to the bladder

Renal Colic

The renal pelvis and the ureter send their afferent nerves into the spinal cord at segments T11 and 12 and L1 and 2. In renal colic, strong peristaltic waves of contraction pass down the ureter in an attempt to pass the stone onward. The spasm of the smooth muscle causes an agonizing colicky pain, which is referred to the skin areas that are supplied by these segments of the spinal cord, namely, the flank, loin, and groin.

When a stone enters the low part of the ureter, the pain is felt at a lower level and is often referred to the testis or the tip of the penis in the male and the labium majus in the female. Sometimes, ureteral pain is referred along the femoral branch of the genitofemoral nerve (L1 and 2) so that pain is experienced in the front of the thigh. The pain is often so severe that afferent pain impulses spread within the central nervous system, giving rise to nausea.

Traumatic Ureteral Injuries

Because of its protected position and small size, injuries to the ureter are rare. Most injuries are caused by gunshot wounds and, in a few individuals, penetrating stab wounds. Because the ureters are retroperitoneal in position, urine may escape into the retroperitoneal tissues on the posterior abdominal wall.