In the female pelvis, the ureter is crossed superiorly by the uterine artery at what level, and what is the clinical significance?
- A At the pelvic brim where ureter crosses the common iliac artery; risk during appendectomy
- B At the ureterovesical junction only; no significance during hysterectomy
- C At the level of the ischial spine (~1.5 cm lateral to the cervix); ureter may be accidentally ligated or cut during hysterectomy ✓
- D In the retroperitoneum at L4 level; risk during lumbar surgery
Correct answer: C. At the level of the ischial spine (~1.5 cm lateral to the cervix); ureter may be accidentally ligated or cut during hysterectomy
Explanation
The uterine artery crosses above (superior to) the ureter at the level of the ischial spine, approximately 1.5–2 cm lateral to the cervix — summarized by the mnemonic 'water under the bridge' (ureter = water, uterine artery = bridge). During hysterectomy, when the uterine artery is clamped and ligated at its origin, the closely applied ureter may be inadvertently injured. This is the most common site of ureteric injury in gynecological surgery. The ureter also crosses the pelvic brim over the common iliac artery — relevant in pelvic lymph node dissections.
Reference: BD Chaurasia's Human Anatomy, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.