During a radical hysterectomy, the ureter is at greatest risk of injury at which specific anatomical point in the pelvis?

• A Where it passes beneath the uterine artery in the base of the broad ligament ('water under the bridge') ✓
• B As it crosses the bifurcation of the common iliac artery
• C At the pelvic brim where it enters the true pelvis
• D As it enters the bladder trigone posterolaterally

Explanation

The classic danger point for ureteric injury in pelvic surgery is where the ureter passes immediately below the uterine artery at the level of the lateral cervix — famously remembered as 'water (ureter) under the bridge (uterine artery).' Here the two structures are separated by only a few millimetres within the cardinal ligament. Clamping or ligating the uterine artery without careful identification of this relationship leads to inadvertent ureteric ligation or transection. Though the ureter is also near the common iliac artery bifurcation, that crossing is easier to visualise and less frequently injured.

Reference: BD Chaurasia's Human Anatomy, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.