Anatomy of the kidney and ureter

A good understanding of the anatomy of the kidney and ureter is imperative while dealing with patients with abdominal trauma and those undergoing abdominopelvic surgery. The kidneys are situated in the retroperitoneum and are enveloped by the renal fascia. The renal fascia prevents the extravasation of blood during renal trauma. The lower poles of the kidneys are more prone to trauma as they are inferior to the 12th rib. However, due to the proximity of the kidneys to the lower ribs and pleura there is a risk of pleural injury during percutaneous renal interventions. Relative paucity of blood vessels in the postero-lateral convex border of the kidney (Brodel's bloodless line) provides a relatively safe access to the pelvicalyceal system. The ureter has an abdominal and pelvic course and has three physiological narrowings: the uretero-pelvic junction, the point where the ureters cross the common iliac artery and the intra-vesical part of the ureter. These are the commonest sites for impacted calculi. The intra-vesical portion of the ureter is the narrowest portion of the ureter and this oblique intramural course helps in the formation of a functional sphincter that prevents vesico-ureteric reflux. The ureter is at risk of injury during colonic, vascular and gynaecological surgery.