During a total abdominal hysterectomy, the ureter is at greatest risk of being clamped or ligated at which point along its course?
- A Where it crosses the pelvic brim over the iliac vessels
- B Where it enters the bladder at the trigone
- C Where it passes beneath the uterine artery near the cervix ✓
- D Where it lies on the psoas muscle in the upper abdomen
Correct answer: C. Where it passes beneath the uterine artery near the cervix
Explanation
The classical surgical teaching is 'water under the bridge': the ureter passes beneath the uterine artery about 1.5 to 2 cm lateral to the cervix, making this the commonest site of iatrogenic injury during hysterectomy. Crossing the pelvic brim is a recognised but less frequent injury site, typically in ovarian pathology. Injuries here are often silent initially and present later with a urinary leak or postoperative hydronephrosis.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
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