During hysterectomy, the ureter is at greatest risk of injury at which specific anatomical location in the broad ligament?

• A Where the ureter enters the pelvis at the pelvic brim crossing the bifurcation of the common iliac artery
• B Within the infundibulopelvic ligament alongside the ovarian vessels
• C As the ureter passes under the uterine artery ('water under the bridge'), 1–2 cm lateral to the cervix ✓
• D Where the ureter enters the bladder at the trigone

Explanation

The most common site of ureteric injury during hysterectomy is at the point where the ureter passes under the uterine artery approximately 1–2 cm lateral to the internal cervical os — classically remembered as 'water flows under the bridge' (ureter runs under/inferior to the uterine artery). The ureter can be kinked, ligated, or transected when the uterine pedicle is clamped. The pelvic brim crossing is another vulnerable site (during pelvic lymphadenectomy or uterovaginal prolapse repair). The infundibulopelvic ligament contains the ovarian vessels; the ureter runs medially close to it during oophorectomy.

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

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Written and medically reviewed by the StethoPrep medical team.