Define Ureter

The ureters are smooth muscle tubes which transport urine from the kidneys to the bladder. The ureters of an adult human measure typically 20–30 cm (8–12 in) long and 3–4 mm (0.12–0.16 in) in diameter. Urothelial cells, a form of transitional epithelium, line the ureter, which also has a smooth muscle layer throughout the third section closest to the bladder which aids in peristalsis.

The ureter is a tube that connects the kidney to the urinary bladder and transports urine. Each kidney has two ureters, one for each kidney. The ureter's upper half is found in the abdomen, while the right ureter is found in the pelvic region. In an adult person, the ureter is 10 to 12 inches in length. A variety of diseases, such as urinary tract infections and kidney stones, can damage the ureters. Stenosis occurs when a ureter narrows as a result of chronic inflammation, for instance. The presence of two ureters on the very same hand or abnormally located ureters are examples of congenital ureter abnormalities. In addition, urinary reflux from the bladder up the ureters is a normal occurrence in infants.


Ureter Meaning

Ureter meaning tells that ureters have been known for the past two thousand years, through the word "ureter" originating from the root uro-, which means "to urinate," and is documented in written documents since at least Hippocrates' period. However, the word "ureter" has only been regularly used to apply to the current structure since the 1500s, and techniques including CT, X-ray, and ultrasound had the ability to display the ureters since the development of medical imaging in the 1900s. The ureters can also be seen from inside utilizing ureteroscopy, a versatile camera that was first identified in 1964.

Ectopic Ureter: Ectopic ureter (also known as ureteral ectopia) is a pathological disorder in which the ureter, instead of ending at the urinary bladder, ends somewhere else. This location is normally the urethra in males and the urethra or vagina in females.

Distal Ureter: On CT, the distal ureter was described as being distal to the sacroiliac joint, with the largest diameter in three planes. The reporting radiologist assessed the stone's location and scale. The middle ureter runs from the sacrum's upper to lower edges. The distal ureter runs from the sacrum's lower boundary to the bladder.

Proximal Ureter: The renal pelvis has been at the ureter's proximal end, and the bladder is at the distal end. The ureter starts behind such structures, just at the stage of the renal artery and vein. The ureteropelvic junction on the left normally corresponds to the second lumbar vertebra, while the right is slightly lower.

Dilated Ureter: Hydroureter, on the other hand, is known as ureter dilation. Hydronephrosis and hydroureter obstruction may be physiologic or pathologic. It can be acute or chronic, unilateral or bilateral, and it can be unilateral or bilateral. This can occur as a result of a urinary tract obstruction, but it could also occur in the absence of obstruction.


Parts of Ureter

The ureter is 25-30 cm in length and is divided into three sections:

  • Abdominal Ureter: It involves the area from the renal pelvis to the pelvic brim.

  • Pelvic Ureter: It includes the area from the pelvic brim to the bladder.

  • Intravesical or Intramural Ureter: Inside the bladder wall.


Structure

The ureters comprise tubular structures which move from the pelvis within each kidney into the bladder, measuring around 20–30 cm (7.9–11.8 in) in adults. These fall from the renal pelvis on peak of the psoas major muscle to the brim of the pelvis. They pass at the front of the popular iliac arteries at this stage.

They subsequently travel down the length of the pelvis before bending over and entering the bladder from the left and right sides at the bladder's back. The ureters have a diameter between 1.5–6 mm (0.059–0.236 in) and are covered by a smooth muscle layer about 1–2 cm (0.39–0.79 in) around the ends until entering the bladder. The ureters penetrate the bladder from the back and move 1.5–2 cm (0.59–0.79 in) until opening at an angle on the bladder's external back surface at the ureteric orifices. The vesicoureteric junction is another name for this spot.


Clinical Significance

  1. Ureteral Stones: A kidney stone may pass through the kidney and settle in the ureter, obstructing urine flow and causing a severe cramp throughout the back, hand, or lower abdomen. A renal colic is a form of pain that comes in waves that last up to two hours before subsiding. If a portion of the kidney remains swollen due to a restricted urine flow, hydronephrosis can grow.

There have been three places in the ureter in which a kidney stone can get trapped: in which the iliac blood vessels pass the ureters; and where the ureters join the urinary bladder. Nevertheless, a retrospective research paper of where stones embedded based on medical imaging did not reveal many stones at the place in which the iliac blood vessels cross.

  1. Anatomical and Surgical Abnormalities: The ureter may become blocked or obstructed as a consequence of narrowing inside the ureter or fibrosis or compression of the structures surrounding the ureter. Ureteric stones, cancerous tumours, as well as other lesions including endometriosis, and schistosomiasis may all cause narrowing. Constipation and retroperitoneal fibrosis, for example, may compress the ureters from the outside. The ureters will narrow as a consequence of certain congenital abnormalities. Ten percent of children have ureter and urinary tract congenital conditions. These involve partial or complete ureter duplication (a duplex ureter), the development of a second abnormally placed (ectopic) ureter, or even the creation of a ureterocele in which the junction with the bladder is malformed.

  2. Cancer: Ureteral cancer is a form of cancer that affects the ureters. Cancer of the urothelium, the cells which form the surface of the ureters, is the most common cause. Urothelial cancer is much more common among men than women just after the age of 40; several risk factors such as smoking and dye exposure to aromatic amines and aldehydes. Blood in the urine has been the most frequent symptom of cancer in an afflicted person; it does not produce illness, and a physical medical examination could be quite normal, other than in late disease. Ureteral cancer is quite often caused by cancer of the ureter's cells, known as transitional cell carcinoma, but it may also arise as squamous cell carcinoma unless the form of cells lining the urethra has altered because of chronic inflammation, including from stones or schistosomiasis.

  3. Injury: Urinary tract injuries may happen as a consequence of penetrating abdominal injuries or high-speed injuries accompanied by an abrupt stop (for example, a high speed car accident). During surgery to surrounding structures, the ureter may be damaged. It is harmed in 2 out of every 10,000 vaginal hysterectomies and 13 out of every 10,000 abdominal hysterectomies, normally close to the ovary's suspensory ligament or the cardinal ligament, in which the ureter passes close to the uterus' blood vessels.

  4. Imaging: The ureter and urethra and urinary tract can be seen using a variety of medical imaging techniques. Due to hydronephrosis of the kidneys and renal pelvis, ultrasound might become capable of displaying signs of blockage. CT scans, such as those with intravenous contrast media to clearly display the ureters and with contrast to best show lesions and distinguish benign from malignant lesions.

FAQs (Frequently Asked Questions)

Q1. What Is the Maximum Amount of Time a Stone Can Remain in the Ureter?

Ans. When a stone hits the bladder, it usually passes within several days, but it can take much longer in some cases, particularly in older men with large prostates. However, even if the stone has been in the ureter, pain will subside, so that if the stone does not move within 4-6 weeks, imaging should be done.

Q2. What is Ureteritis?

Ans. Ureteritis is an inflammatory disease that affects the ureter. "Ureteritis cystica" is one type of ureteritis. It has been discovered that eosinophilic ureteritis exists. Uretritis is sometimes mistaken for a urinary tract infection.