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The anatomy of the kidney and ureter

  • Harold Ellis
    Affiliations
    Harold Ellis CBE FRCS was professor of Surgery at Westminster Medical School until 1989. Since then he has taught anatomy, first in Cambridge and now at Guy’s Hospital, London, UK
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      Abstract

      The kidneys are placed retroperitoneally on the posterior abdominal wall, the right lower than the left. At the renal hilum are found, from before back, the renal vein, artery, pelvis of the ureter and a small posterior artery branch. There are also lymphatics and sympathetic fibres (T12–L1), which account for referred renal pain to the lower abdominal wall and external genitalia. The pelvis of the ureter divides into two or three major calyces, which divide into minor calyces, each indented by a renal papilla, onto which discharge the renal tubules. The three fascial layers are: the capsule, which is easily stripped from the healthy kidney; the perinephric fat; and the investing renal fascia, which adheres to the structures at the hilum and usually tamponades a closed rupture of the kidney, which can thus be treated conservatively. The ureter is 25 cm long, comprising the pelvis and an abdominal, pelvic and vesical portion; the last acting as a sphincter. The ureter is crossed by the gonadal vessels and may be injured here in gynaecological surgery. The ureter can be identified as it constantly crosses the common iliac artery at its bifurcation and then lies on the anterior aspect of the internal iliac artery.

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