Johnny Silva Cancer Research

Clinical features Wvs

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1 The ureter is readily identified in life by its thick muscular wall which is seen to undergo worm-like (vermicular) writhing movements, particularly if gently stroked or squeezed.

2 Throughout its abdominal and the upper part of its pelvic course, it adheres to the overlying peritoneum (through which it can be seen in the thin subject), and this fact is used in exposing the ureter — as the parietal peritoneum is dissected upwards, the ureter comes into view sticking to its posterior aspect.

Fig. 84 Drawing from an intravenous pyelogram to show the relationship of the ureters to the bony landmarks.

3 The ureter is relatively narrowed at three sites:

• at the junction of the pelvis of ureter with its abdominal part,

• at the ureteric orifice (narrowest of all).

Aureteric calculus is likely to lodge at one of these three levels.

4 In searching for a ureteric stone on a plain radiograph of the abdomen, one must imagine the course of the ureter in relation to the bony skeleton (Fig. 84). It lies along the tips of the transverse processes, crosses in front of the sacroiliac joint, swings out to the ischial spine and then passes medially to the bladder. An opaque shadow along this line is suspicious of calculus. This course of the ureter is readily studied by examining a radiograph showing a radio-opaque ureteric catheter in situ.