Clinical features

The most important single practical relationship in this region is that of the ureter to the supravaginal cervix. At this point, the ureter lies just above the level of the lateral fornix, below the uterine vessels as these pass across within the broad ligament (Fig. 104). In performing a hysterectomy, the ureter may be accidentally divided in clamping the uterine vessels, especially when the pelvic anatomy has been distorted by a previous operation, a mass of fibroids, infection or malignant infiltration.

Uterine Position
Fig. 103 Variations in uterine position and their terminology.

Fig. 104 Lateral view of the uterus (schematic) to show composition of the broad ligament, the relations of ureter and uterine artery, and the peritoneal covering of the uterus (pink stippled).

Fig. 104 Lateral view of the uterus (schematic) to show composition of the broad ligament, the relations of ureter and uterine artery, and the peritoneal covering of the uterus (pink stippled).

Bilateral View Uterus

The ureter is readily infiltrated by lateral extension of a carcinoma of the uterus; bilateral hydronephrosis with uraemia is a frequent mode of termination of this disease.

The close relationship of ureter to the lateral fornix is best appreciated by realizing that a ureteric stone at this site can be palpated on vaginal examination. (This is the answer to the examination question: 'When can a stone in the ureter be felt?')

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