unilateral flank pain, colicky, radiates to back and groin + haematuria…
unilateral flank pain, colicky, radiates to back and groin + haematuria
Path & Landmarks
- What is the course of the ureters? Trace on X-ray KUB
- What are the anatomical landmarks used to identify the path of the ureters?
- Begins descent @ PUJ
- Along medial aspect of psoas, anterior and slightly medial to tips of L2-5 transverse processes
- Down TP, enters pelvis
- Anterior to SI joint @ bifurcation of CIA
- Anterior to IIA, along lateral pelvic sidewall
- Ischial spine level: turns medially and anteriorly
- Enters bladder posterolateral wall
- Via ureteric orifices of bladder trigone → bladder
- What are the sites of obstruction in the ureter?
- CIA bifurcation at pelvic brim
- VUJ, enters bladder wall
Innervation & Pain
- What's the innervation of the ureters?
- How does this contribute to symptoms of renal colic?
- spinal transmission through ascending spinothalamic tract
- sympathetic efferent sensory fibres (from ureters)
- to spinal cord T11-L2 (via dorsal nerve roots)
- pain referred to T11-L2 dermatome
- back & sides of abdo, upper aspect of anterior thigh
- men (scrotum), women (labia)
- pain signals through GF and II nerves
- pelvic splanchnic nerves (nervi erigentes)
- innervate intramural ureter/bladder
- enter spinal segment S2-S4
- bladder symptoms if intramural ureteral calculus
X-ray mimics of renal stones
If you see a radiodense/opaque lesion OR calcification on X-ray, what could it be?
- pancreatic calcifications
- cholelithiasis (overlying R kidney)
- renal artery calcifications