During a total abdominal hysterectomy, the ureter is most commonly injured at which anatomical site?

• A At the pelvic brim where it crosses the common iliac artery
• B At the level of the infundibulopelvic ligament
• C At the ureterovesical junction
• D Where it passes under the uterine artery (water under the bridge) near the cervix ✓

Explanation

The ureter passes under the uterine artery approximately 1.5-2 cm lateral to the cervix, a relationship classically described as 'water under the bridge'. This is the most common site of ureteric injury during hysterectomy, particularly when clamping the cardinal ligaments or uterine vessels. Injury here can lead to ureterovaginal fistula. The infundibulopelvic ligament is relevant during salpingo-oophorectomy.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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