During an abdominal hysterectomy, the ureter is injured. At which point along its pelvic course is iatrogenic ureteric injury most likely to occur?

• A Where it crosses the pelvic brim over the iliac vessels
• B Where it enters the kidney at the hilum
• C Where it lies on the psoas muscle lateral to the ovary
• D Where it passes beneath the uterine artery near the cervix ✓

Explanation

The commonest site of gynaecological ureteric injury is the segment within 2 to 3 cm of the ureterovesical junction, where the ureter passes beneath the uterine artery close to the cervix and lateral vaginal fornix, classically remembered as water flowing under the bridge. Injuries also occur at the infundibulopelvic ligament where the ovarian vessels cross it. The pelvic brim crossing and lumbar segments lie away from the operative field of hysterectomy and are far less frequently involved.

Reference: Gray's Anatomy, 42nd ed.

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