During hysterectomy, the ureter is most commonly injured at which specific anatomical point in the female pelvis?

• A As it crosses the pelvic brim at the bifurcation of common iliac artery
• B Where it enters the bladder trigone
• C At the point where it passes under the uterine artery ('water under the bridge') in the cardinal ligament ✓
• D In the retroperitoneal space of the broad ligament

Explanation

The ureter is classically injured during hysterectomy at the cardinal (Mackenrodt's) ligament, where the uterine artery crosses over the ureter — 'water under the bridge' (ureter = water, uterine artery = bridge). The ureter passes approximately 1.5 cm lateral to the cervix at this point. During ligation of the uterine artery, the ureter can be inadvertently ligated, kinked, or transected. This is the most common site of ureteral injury in gynecological surgery. Surgeons identify the ureter before clamping the uterine artery to prevent this complication.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.