In female pelvic anatomy, the ureter passes beneath the uterine artery (water under the bridge) as it courses to the bladder. At what specific anatomical point is the ureter most at risk during hysterectomy?

• A As it passes 1–2 cm lateral to the cervix at the level of the internal os, beneath the uterine artery ✓
• B As it crosses the pelvic brim at the bifurcation of the common iliac artery
• C As it enters the posterior wall of the bladder trigone
• D As it passes posterior to the ovarian fossa near the internal iliac artery origin

Explanation

The ureter is most commonly injured during hysterectomy at the point where it passes approximately 1–2 cm lateral to the cervix (at the level of the internal os) and runs beneath the uterine artery — the classic 'water under the bridge' relationship. The ureter enters the parametrium here and can be inadvertently ligated or transected when clamping the cardinal ligament or uterine vessels. The second most common site of injury is the infundibulopelvic ligament ligation (near the pelvic brim). Recognition requires pre-operative ureteral stenting or careful dissection.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.