During a hysterectomy, the ureter is most at risk of injury at which specific anatomical location?
- A Where it passes under the uterine artery ('water under the bridge') approximately 1.5 cm lateral to the uterine cervix ✓
- B At the pelvic brim where it crosses the common iliac artery
- C At the bladder trigone where it enters the bladder
- D Where it crosses posterior to the ovarian vessels
Correct answer: A. Where it passes under the uterine artery ('water under the bridge') approximately 1.5 cm lateral to the uterine cervix
Explanation
The most common site for ureteric injury during hysterectomy is where the ureter passes under the uterine artery (the 'water under the bridge' relationship — ureter is the 'water' running below the uterine artery 'bridge'). This crossing occurs approximately 1.5–2 cm lateral to the supravaginal cervix. If the uterine artery is clamped and ligated here without identifying the ureter, it may be included in the clamp, leading to ligation or transection of the ureter.
Reference: BD Chaurasia's Human Anatomy, 8th ed.
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Written and medically reviewed by the StethoPrep medical team.