There are no three physiological narrowings in the upper urinary tract: a new concept of the retroperitoneal anatomy around the ureter

Minobu Kamo, Taiki Nozaki, Saya Horiuchi, Natsuka Muraishi, Jin Yamamura, Keiichi Akita

Research output: Contribution to journalReview articlepeer-review

3 Citations (Scopus)

Abstract

The widely held dogma of three physiological narrowings in the upper urinary tract has proven incorrect by recent several studies using computed tomography images. There are only two common obstruction sites: the upper ureter and the ureterovesical junction. The second narrowing, where the ureter crosses the iliac vessels, cannot be regarded anymore as a common obstruction site. The mechanism by which stones lodge in the upper ureter is explained anatomically by the change in ureteral mobility and compliance at the level where the ureter exits the perirenal space. This level can be identified radiologically as the point where the ureter crosses under the ipsilateral gonadal veins, termed the “crossing point”. Kinking of the upper ureter is another manifestation of this anatomical phenomenon, visible in radiological images. It is caused by loosening of the ureter at or above the crossing point (within the perirenal space), corresponding with renal descent such as during the inspiratory phase. This new anatomical discovery in the retroperitoneum will not only bring about a paradigm shift in terms of the physiological narrowings in the upper urinary tract, but may also lead to the development of new surgical concepts and approaches in the area.

Original languageEnglish
Pages (from-to)407-413
Number of pages7
JournalJapanese Journal of Radiology
Volume39
Issue number5
DOIs
Publication statusPublished - 2021 May
Externally publishedYes

Keywords

  • Anatomy
  • Computed tomography
  • Crossing point
  • Retroperitoneal space
  • Ureter
  • Urinary stone

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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