The ureter enters the pelvis by crossing the pelvic brim at the bifurcation of the common iliac artery. In the female pelvis, the ureter passes beneath which structure — the most clinically dangerous cross-point during hysterectomy?
- A Uterine artery (water flows under the bridge) ✓
- B Ovarian ligament
- C Round ligament
- D Cardinal (Mackenrodt's) ligament from above
Correct answer: A. Uterine artery (water flows under the bridge)
Explanation
The ureter passes beneath the uterine artery ('water flows under the bridge') approximately 2 cm lateral to the cervix. This relationship is the most common site of ureteral injury during hysterectomy — when the uterine artery is clamped, divided, or ligated, the ureter immediately beneath may be inadvertently included. The mnemonic 'water (ureter) under the bridge (uterine artery)' is classical. Ureteral injury occurs in 0.1–1% of hysterectomies; recognition requires careful ureteral identification during dissection of the parametrium.
Reference: BD Chaurasia's Human Anatomy, 8th ed.
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Written and medically reviewed by the StethoPrep medical team.