During Hysterectomy, Ureter is liable for injury at?
Where it crosses uterine aery REF: Novak's Gynecology chapter 5, chapter 22 "About 75% of all iatrogenic injuries to the ureter result from gynecologic procedures, most commonly abdominal hysterectomy" "Significant aerial bleeding during hysterectomy usually arises from the uterine aeries or the ovarian vessels near the inseion of the infundibulopelvic ligaments. Blind clamping of these vessels presents a risk for ureteral injury; therefore, the ureters should be identified in the retroperitoneal space and traced to the area of bleeding to avoid inadveent ligation" At about the level of the ischial spine, the ureter crosses under the uterine aery in its course through the cardinal ligament; the ureter divides this area into the supraureteric parametrium surrounding the uterine vessels and the infraureteric paracervix molded around the vaginal vessels and extending posteriorly into the uterosacral ligament. In this location, the ureter lies 2 to 3 cm lateral to the cervix and in proximity to the inseion of the uterosacral ligament at the cervix. This proximity warrants caution when using the uterosacral ligament for vaginal vault suspension
Where it crosses pelvic brim
Where it enters bladder wall.
Where it crosses uterine aery.
None