During an abdominal hysterectomy, the surgeon ligates the uterine artery at the level of the cervix. Which part of the ureter is at greatest risk of injury at this step?

• A Ureteropelvic junction
• B Segment passing beneath the uterine artery near the lateral vaginal fornix ✓
• C Segment crossing the pelvic brim over the iliac vessels
• D Intramural segment within the bladder wall

Explanation

The ureter runs about 1 to 2 cm lateral to the cervix and passes beneath the uterine artery, giving rise to the teaching phrase water runs under the bridge. Ligation of the uterine artery during hysterectomy is therefore the classical point of iatrogenic ureteric injury. The crossing over the iliac vessels at the pelvic brim is at risk during colorectal and vascular procedures, while the intramural segment is vulnerable during bladder and prostate surgery.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.