The ureter is divided into the abdominal part (pars abdominalis) – from the renal pelvis to the border line (linea terminalis) and pelvic part (pars pelvina), located in the small pelvis.
The ureter has three narrowings, where its diameter decreases to 2-3 mm: at the transition of the pelvis to the ureter, at the border line and before entering the bladder.
The wall of the ureter consists of three layers.
Outer layer – tunica adventitia (tunica adventicia) – consists of loose connective tissue.
The middle layer is the muscular layer (tunica muscularis) – consists of several layers of smooth muscle.
In the abdominal part, the inner layer consists of longitudinal, and the outer layer consists of annular (circular) muscles.
An additional outer layer of longitudinal muscles is formed in the pelvic part.
The inner layer of the ureter is the mucous membrane (tunica mucosa). The ureter is surrounded by periureteric tissue (paraureterium), limited preureteral (fascia preureterica) and ureterorenal (fascia preureterica) fascia, which is a continuation downward of the prerenal and retrorenal (fascia retrorenalis) fascia. The spurs of the preureteral fascia connect the ureter with the peritoneum, this contributes to the fixation of the ureter. When the peritoneum is separated from the posterior wall of the abdomen, the ureter moves away along with the peritoneum.
The wall of the ureter has a great ability to stretch (in pathological conditions the ureter can reach enormous thickness), therefore, under normal conditions, urine does not enter the bladder continuously, but periodically, as it accumulates in the ureter and expands the latter.
Blood supply, innervation, blood and lymph drainage
Blood supply the ureter is carried out by the ureteric branches (rr. ureterici), extending from the renal (a. renalis), testicular (ovarian) [ a. testicularis (ovarica)] arteries, abdominal aorta (aorta abdominalis), common iliac artery (A.orasacommunis) and inferior vesical artery (a. vesicalis inferior)
Innervation of the ureter:
Inferior splanchnic nerve ( n.splanchnicus imus) from Th XII and the renal plexus provide sympathetic innervation to the renal pelvis.
Lumbar splanchnic nerves (pp.splanchnici lumbales) from L I -L II provide sympathetic innervation of the abdominal and pelvic parts of the ureter.
Pelvic splanchnic nerves (pp.splanchnici pelvini) from S II -S IV provide parasympathetic innervation of the ureter.
Sensitive nerve fibers from various parts of the ureter approach the spinal cord as part of the nearest splanchnic nerve.
Obstruction of the ureter by a calculus in the upper narrowing is manifested by pain in the lumbar region (Th XII and L I).
Obstruction of the ureter by a calculus at the border line is manifested by pain in the inguinal and pubic regions, in the anterior part of the scrotum and in the upper part of the anterior thigh (L I and L II).
When the parietal part of the ureter is obstructed, pain occurs in the perineum and along the back of the thigh (S I -S II).
LARGE VESSELS OF THE RETROPERITONEAL SPACE
The ureter is a thin duct connecting the kidney and bladder, through which urine is removed from the kidney to the bladder. The structure and functions of the ureters provide normal work urinary system. Each kidney has its own ureter, which leaves the renal pelvis and enters the bladder. The length of each ureter is about 30 cm, the diameter ranges from 4 to 7 mm. The size of the ureter is great importance at urolithiasis. Stones larger than 4 mm cannot be freely passed through urine into the bladder and lead to the development of renal colic.
Ureter: structure of the abdominal and pelvic parts
From the renal pelvis, the ureter goes downward and into the middle and small pelvis, where it enters the bladder, perforating its wall in an oblique direction. Each ureter has an abdominal and a pelvic part. The abdominal part of the ureter is located in front of the psoas major muscle. In front of the right ureter is the descending tract duodenum, vessels and base of the mesentery small intestine. Anterior to the left is the duodenojejunal flexure, vascular bundle and base of the mesentery
In the pelvis, the ureters pass in front iliac arteries and veins The diameter of the ureter in this part is narrowed. In men, it passes in front of the vas deferens and enters the bladder below the upper pole. In the pelvic part, the ureters in women are surrounded by other organs: the ureter runs along the edge of the ovary and uterine cervix, and enters the bladder on the side of the vagina.
The part of the ureter located inside the wall is called intramural. Bladder.
Ureter: wall structure
The wall of the ureter, like the renal pelvis with the cups, consists of three membranes: the outer one - made of connective tissue, the inner one, covered from the inside with transitional epithelium with mucous glands, and the middle one, consisting of two layers of muscle - longitudinal and circular. The musculature of the ureters is not connected to the muscular layer of the bladder and prevents urine from flowing back from the bladder into the ureter.
At the point where the ureter enters the bladder, in its wall there is a layer of longitudinal muscles, closely connected with the muscular layer of the bladder. This layer actively prevents urine from flowing back into the ureter. The presence of this layer limits the spread of infection from the bladder to the ureter and further to the kidneys.
Ureter: structure of the lumen
The lumen of the ureter has several narrowings:
The first narrowing is located at the junction of the pelvis and the ureter;
The second is located on the border between the abdominal and pelvic parts;
The third narrowing can be located in any part of the pelvic part;
The fourth narrowing is located near the wall of the bladder.
The presence of natural has great clinical significance. Stones that come out of the renal pelvis and move with the flow of urine towards the bladder get stuck in these areas.
Along the ureter, in addition to anatomical narrowings, there are physiological narrowings that appear and disappear during peristalsis.
Ureter: structure of blood supply and innervation
The upper part of the ureter receives blood from branches arising from the renal and testicular or ovarian arterial vessels. The middle part is supplied with blood from the ureteric branches arising from the abdominal aorta and iliac arteries. The lower part is from the vesical and middle rectal arteries. The outflow of blood occurs into the internal iliac and lumbar veins.
The ureter is innervated from the next few autonomic nerve plexuses. Branches vagus nerve and the pelvic splanchnic nerves provide parasympathetic innervation.
A thin, long-shaped tube is called the ureter. It extends from the renal pelvis, then directly to the bladder. Its location is behind the abdominal space, reaches 34 cm, the minimum value of the indicator is about 24 cm. It is worth noting that the right and left ureters differ in their length. Due to its location, the right side is smaller than the left.
Features of the structure of the ureters
Thanks to anatomy genitourinary system it is possible to trace the muscle layer in the ureters, which contributes to normal movement urine to the bladder. This layer also serves as protection against the reverse process. The inner part of the ureters is lined with epithelium; on the outside, a sheath of fascia is visible.
Where the depression is visible, smooth muscle fibers can be seen in large quantities. When they contract, they prevent the outflow of urine into the kidney organs in the opposite way.
According to their structure, the ureters are characterized by three narrowings:
- Transition of the pelvis to the ureter;
- the middle third, that is, the place that smoothly passes into the small pelvis;
- the third narrowing is the mouth.
Stone formations tend to get stuck in these parts. It is worth describing each narrowing in more detail and characterizing each one.
- This segment is also called the ureteropelvic segment. If the stone is more than two centimeters in diameter high probability that he will get stuck in this very place.
- The area when crossed becomes narrower to 4 mm.
- This segment is called the vesicoureteral segment. Its diameter becomes narrower to 1-5 mm. Most stones get stuck in this narrow area.
The place where stones form is called the renal pelvis. This is where they get stuck. They occur with the same frequency of formation in both the left and the right side ureter.
Most often, ureteral stones form in the kidney area. Accordingly, their composition is identical. The most common stones are composed of calcium oxalates.
Factors for stone passage
When planning an effective course of treatment, it is worth considering two main factors: the size and location of the stones. If the size of the stone does not exceed 4 mm, almost always (90% of cases), surgical intervention will not be required; the formations will leave the body on their own. If the stone diameter reaches 9 mm, then such successful predictions are reduced to 50%. There is practically no chance of independent exit from the proximal part. This is where surgery will most often be needed.
Experts identify a characteristic term that sounds like “stone path.” Its significance lies in the collection of fragments of stones that formed over time, perhaps got stuck, or provoked the development of ureteral obstruction in men.
4 main symptoms
Characteristic symptoms appear in cases where a stone gets stuck in the ureter. The man feels severe pain and colic of a fairly intense nature. Uncomfortable sensations begin suddenly and end just as quickly. Such symptoms are associated with the location of the stone. Depending on this, there are several main symptoms that are characteristic of each department:
- In cases where small stones are in the cup, it is most often bright severe symptoms will not be. Their presence is discovered in most cases by accident during an x-ray or other examination. Such formations can provoke the development of infectious diseases, severe pain. If the stones are large enough, obstruction of the cervix in the calyx area is possible.
- If stones are located in the renal pelvis, they cause obstruction. The pain in this case is predominantly on the side. If, against the background of stone formations, infection, the patient is likely to develop pyelonephritis or sepsis. With small formations there will be no symptoms.
- In cases where stones are located in the proximal region of the ureter, pain of an acute nature is observed, its manifestations begin quite unexpectedly. As the stones pass, the location of the pain also changes accordingly.
- If the stones are in the distal parts, then painful sensations accompany the inguinal canal, the external part of the genital organs. If the stones are located directly in the area of the vesicoureteral part, in such cases manifestations of frequent urination are possible.
There are certain symptoms that, if observed, require urgent hospitalization:
- If a person has one kidney, stone formation is detected;
- unbearable pain, which requires the use of an analgesic;
- the patient has fever or leukocytosis;
- feelings of nausea, attacks of vomiting, their frequent manifestations;
- manifestations of azotemia.
Diagnostics
Urethra ( urethra) is an important ally in diagnosis of this manifestation. In this case, the data obtained after palpation, as well as additional measures, are taken into account.
Stones in the ureter in men are diagnosed by palpation in the part of the urethra that hangs, in the perineal part. Rectal examination is necessary in cases where stones are located in the posterior compartments.
Ultrasound of the bladder is used, which makes it possible to detect an acoustic shadow in the urethra. A urine test is required, which will help in determining the inflammatory process.
Another method is to insert a metal bougie into the urethra. There may be a feeling of obstruction or slight friction.
To diagnose the differential type, urography and urethroscopy are used.
Stones in the prostate (prostate gland)
According to statistical research, about 40% of men experience this disease from 8 to 10 years from diagnosis of the disease. The cause of this disease is the chronic nature of prostate diseases. This process is accompanied by stagnant manifestations in the prostatic secretion. In addition, with constant overwork, stressful situations, hypothermia and the presence of addictions, stones begin to form in this place over time in men. In addition, violation of personal hygiene rules, an inactive lifestyle and sex life irregular in nature. It is also important to undergo examinations for the presence of formations to minimize the occurrence of formations. inflammatory diseases in the urinary system.
Action tactics
First of all, it is necessary to clearly know the size of the stone and its location. If the diameter of the formations does not exceed five mm, do not worry, they will come out on their own. Your doctor may prescribe an increase in the amount of fluid you drink per day, in particular clean water. Analgesics are prescribed.
It is necessary to carry out review procedures and urograms every two weeks, which show the dynamic development of stone movements. The patient needs to filter the urine to preserve the analysis for stones. Individually, the patient should monitor himself for the presence or absence of the following symptoms:
- Fever;
- infectious diseases in the urinary system;
- strong, sharp pain;
- uncontrolled attacks of vomiting, severe feeling of nausea.
Treatment
If an infectious disease begins to develop against the background of formations, then it is necessary to begin a course of treatment as soon as possible. In cases where discomfort, there is no pronounced pain, no infections, then the doctor prescribes treatment depending on how the patient feels. If complete obstruction is observed, then the kidney is damaged within 24 hours. In a period of up to two weeks, changes in the kidney organs are irreversible. It is recommended to seek help from specialists as early as possible, undergo high-quality diagnostics and decide on a course of treatment.
Surgical intervention
There are two types of such treatment:
- Complete removal is called prostatectomy;
- Removal of the area where the stone was located is called resection of the prostate.
Preventive measures
In order to avoid such manifestations as the formation of stones in the ureter, it is enough to monitor your health. You need to stick to the basics healthy image, lead an active life, monitor your diet and undergo regular examinations. Timely treatment will protect you from possible complications, long treatment and surgical intervention.
The ureter is a paired urinary organ that serves to drain urine into the bladder.
Structure of the ureter
The ureter begins from a narrowed section of the renal pelvis, where urine formed in the kidney flows. Its outlet end ends in the wall of the bladder. In this place, the mucous membrane forms a fold that prevents the reverse flow of urine. The fold works like a valve, since thanks to the muscle fibers it contains it can actively close.
Externally, the ureter has the appearance of a thin tube, which has an outer shell of connective tissue, a middle muscular layer, the fibers of which are intertwined in different directions, and an internal mucous membrane that forms longitudinal folds along the entire length of the ureter.
Part of the ureter is located in abdominal cavity, and part - in the pelvic cavity. Along its entire length, segments of narrowing alternate with expansions. On average, the diameter of this organ in the abdominal cavity is from 8 to 15 mm, in the pelvis – up to 6 mm. Significant elasticity allows the ureter to expand when there is difficulty in the outflow of urine up to 8 cm, for example, if there are stones in the ureter. The narrowest point is the exit from the renal pelvis, and this is biologically expedient.
Functions of the ureter
The main function of the ureter is the timely removal of urine formed in the kidneys into the bladder. Filled in first upper section ureter, and thanks to contractions of the muscle fibers in its wall, urine moves further into the bladder, even in a horizontal position.
Ureteral examination
The examination begins with the collection of complaints. Most often, patients with ureteral diseases complain of pain syndrome. The pain can be stabbing, aching, paroxysmal, and radiate down the abdomen. Damage to the pelvic region can cause a disturbance in the rhythm of urination - dysuria.
When palpating the abdomen, there may be tension in its anterior wall and pain along the ureter. The lower segment of this organ can be palpated during examination through the vagina in women or the rectum in men.
In urine tests for pathology of the ureters, leukocytes and red blood cells can be detected. Most often this is evidence of inflammatory changes or stones in the ureters.
Cystoscopy allows you to examine the orifices of the ureters in the bladder - their shape, size, location, the presence of blood or purulent discharge. Chromocystoscopy allows you to determine the blockage of urine flow due to a stone in the ureter or damage. The level of damage can be more accurately determined by catheterization, and it can also provide a means of treating the ureter if urinary diversion is necessary.
During survey urography, the ureters are not visible, but radiopaque stones can be seen in them. Their progress is visible during a study with contrast - excretory urography. In these cases, asymptomatic duplication of the ureters can also be detected. When contrast is administered from the bladder cavity, the study is called retrograde ureterography.
Contractile capabilities are studied using X-ray cinematography and electroureterography. These types of examinations make it possible to identify such dysfunctions of the ureter, hypo- or hyperkinesia, hyper- or atony.
Diseases of the ureter and approaches to their treatment
There are congenital and acquired pathologies of the ureters. Congenital diseases occur under the influence of damaging factors on the fetus.
Hypoplasia often occurs when the corresponding kidney is underdeveloped. The diameter of the ureter decreases, in some places it can become obliterated. A narrowing, or stenosis, most often forms in the vesicoureteral segment. In these cases, surgical treatment of the ureter with plastic surgery of the affected segment is possible.
Ureteral valves are a doubling of the inner lining of the organ in the form of a fold; they are quite rare.
Congenital atony is one of the most severe pathologies. Due to the lack of contractions, the ureter expands greatly. Clinically, this may not manifest itself in any way, but persistent pyuria is detected in the urine.
Acquired diseases are mainly the result of obstruction. This may be a consequence of external compression or the presence of an obstruction in the lumen.
From the outside, compression is most often caused by prolonged constipation, kinks of the ureter, gynecological pathology, cancer bladder, prostate, cervix.
With urolithiasis, small stones from the renal pelvis can enter the ureter, disrupting the outflow of urine. Surgery ureterolithotomy is performed to remove stones from the ureter if other methods have been ineffective.
Obstruction of the organ can be caused by other than stones cancer tumor, chronic inflammatory process(for example, with tuberculosis, schistosomiasis). Treatment of ureters will consist of removing the obstruction or surgically removing the ureter and draining the renal pelvis.
With fibrous lesions in the area of retroperitoneal tissue, fibrous polyureteritis occurs. The ureter in this case is covered from the outside fibrous tissue in the form of a coupling that compresses it from the outside. This pathology can also only be corrected surgically.
The ureter in women is a paired tubular organ located retroperitoneally; it connects the renal pelvis with the underlying bladder. Length of ureter adult woman ranges from twenty-nine to thirty-five centimeters. The diameter of the ureter varies along its entire length; in the area of its anatomical narrowings, namely at the exit from the kidney, when passing through the muscular diaphragm of the pelvis, when directly entering through the bladder it is several millimeters; in other places the lumen of the ureter can reach one centimeter , its width may vary.
What parts of the ureter can be identified? There are two of them:
- The abdominal part departs from the pelvis, begins with a bend, then goes downwards, lying on the anterior surface of the lumbar muscle, reaching the pelvic line.
- Pelvic part. In which the ureter is located retroperitoneally, it goes downwards. At the bottom of the bladder it penetrates into it and looks like a slit from the inside.
Layers of the walls of the ureter
- Internal longitudinal;
- Middle circular;
- External longitudinal.
The last layer has separate bundles, their increase is observed at the bottom of the organ.
- The mucous membrane contains longitudinal folds; from the inside, the organ resembles a stellate structure. In the depths lie the tubular-alveolar glands.
The topography of the ureters differs significantly on the right and left sides. The position of the ureter on the right at the beginning is located behind the intestine. The distal part of the urinary tube crosses the base of the suspensory apparatus of the ileum small intestine. When passing into the intramural section of the ureter, the iliac arteries appear in front.
On the left side, the urinary tube may be located behind the bend of the intestine; in the small pelvis, a crossover occurs between the vessels. The ureter in men along its length crosses with the testicular artery, and in women with the ovarian artery.
Inside the pelvis, the topography is the same on both sides, but differs depending on gender.
In men, before entering the bladder, the vas deferens is attached, which runs along the inside.
In women, the urinary tube penetrates the periuterine tissue.
The anatomy and structure of the ureters are the same in both sexes.
Organ laying in intrauterine development
The development of the urinary tube occurs during pregnancy. Moreover, these organs are able to stretch due to the fact that they have longitudinal folds in the mucosa. Under the mucous membrane, glands are located similar in structure to the prostate. A newborn's ureters may still develop for a long time after birth. The ureter develops throughout pregnancy.
To see where the ureter originates and how it can be located, you need to buy a purchased anatomy textbook, which has visual drawings.
Bladder
This is an organ located in the pelvis behind the pubic symphysis. It fills with urine that passes through the opening of the ureter, so its size changes. When it is full, it resembles a pear in appearance. An empty bubble looks like a saucer. It can hold up to eight hundred milliliters of urine. During pregnancy, it should not be allowed to overflow. Because during pregnancy there is pressure on it from the uterus.
The functions of the ureters and bladder are reduced to transport, reservoir and excretory.
Developmental anomalies
The most common option is when 2 urinary tubes come off from the left kidney. There may be two outlets in the bubble, or one. Recovery is carried out surgically. Sometimes you can observe doubling of the left kidney, when there are 2 of them.
Renal colic may occur during pregnancy. At the same time he suffers middle third ureter, or ureteric valve. To determine pain on the body there are certain points of palpation, there are 2 in total. The first points are determined by outer surface rectus abdominal muscles at the level of the navel on both sides. The second, lower ones are located along the same muscles, but the crests of the iliac bones of the pelvis serve as a guide. During pregnancy, these landmarks may not be informative due to the displacement of the urinary tubes by the pregnant uterus and fetus. If the ureter is obstructed by a stone, its size increases sharply distal section, it overstretches, causing intense paroxysmal pain. It can radiate to the groin and external genitalia. The patient cannot find a comfortable position for herself. The pain is not relieved by taking non-narcotic analgesics. It is imperative to seek advice from a specialist. Only he can prescribe appropriate therapy that will help solve this problem and will not harm the fetus and its intrauterine development.
What is a ureteral valve and why does it occur?
A ureteral valve is a block that occurs along the tube, preventing the normal passage of urine. These structures develop in the womb, function for a certain time, and then disappear without a trace. Sometimes they can remain, causing acute urinary retention over time.
Symptoms
Due to overstretching of the renal capsule, intense pain occurs. On initial stage These pains are constant, but tolerable. Complete obstruction mimics all symptoms resembling renal colic. If immediate measures are not taken, stagnation of urine provokes the formation of stones. If such complaints arise, you should immediately contact a specialist.
Diagnosis of this pathology is carried out on the basis of excretory urography. This method allows you to see the ability of the kidneys to excrete using a contrast agent.
Treatment of this pathology is carried out using a cystoscope, which allows you to restore the patency of the urinary tube. If this method cannot be carried out, then resort to surgical treatment. In this case, the urinary tube is opened, the valve is removed, and the surgical wound is sutured layer by layer. If it is not possible to perform an operation, then resort to puncture of the pelvis. Under the control of an ultrasound machine, a catheter is inserted into the pelvis, thus allowing the outflow of urine.
If the pathology is identified in time, urosepsis is prevented, and treatment is carried out, then this pathology can be cured. The prognosis for recovery is always favorable.
