During a hysterectomy the ureter is most vulnerable to injury at which location?
- A As it crosses the common iliac artery
- B At the pelvic brim near the bifurcation of the aorta
- C As it passes under the uterine artery in the base of the broad ligament ✓
- D As it enters the ureterovesical junction
Correct answer: C. As it passes under the uterine artery in the base of the broad ligament
Explanation
The ureter passes approximately 1.5 cm lateral to the cervix and runs beneath the uterine artery in the parametrium (base of the broad ligament). This relationship—remembered as 'water (ureter) under the bridge (uterine artery)'—is the site of greatest surgical risk. Ligation of the uterine artery may inadvertently include the adjacent ureter. Ureteric identification before ligation is the critical preventive step.
Reference: BD Chaurasia's Human Anatomy, 8th ed.
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