The ureter crosses the pelvic brim at which anatomical landmark and is then at highest risk of surgical injury at which point in the female pelvis?

• A Crosses the bifurcation of common iliac artery; most at risk where it passes under the uterine artery ('water under the bridge') ✓
• B Crosses the external iliac artery; most at risk at the pelvic brim
• C Crosses the internal iliac artery; most at risk in the broad ligament
• D Crosses the ovarian artery; most at risk near the uterosacral ligaments

Explanation

The ureter crosses the bifurcation of the common iliac artery at the pelvic brim (a key anatomical relation). In the female pelvis, the ureter is most vulnerable to surgical injury where the uterine artery crosses superior to the ureter — 'the water (ureter) flows under the bridge (uterine artery)' — approximately 1.5–2 cm lateral to the uterine cervix. This is the most common site of ureteral injury during hysterectomy. Ligation of the uterine artery too broadly may incorporate the ureter.

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

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Written and medically reviewed by the StethoPrep medical team.