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Topic

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Right ureter

The right ureter is a muscular tubular structure that conveys urine from the right renal pelvis to the urinary bladder. It measures approximately 25–30 cm in length and is divided into abdominal and pelvic parts. The right ureter begins at the ureteropelvic junction (UPJ), descends vertically along the anterior surface of the psoas major, crosses over the pelvic brim at the sacroiliac joint, and finally enters the bladder at the ureterovesical junction (UVJ).

The ureter has three normal physiological narrowings where calculi are most likely to lodge:

  1. Ureteropelvic junction (UPJ)

  2. Crossing over the iliac vessels at the pelvic brim

  3. Ureterovesical junction (UVJ)

Relations

  • In the abdomen: lies anterior to the psoas major and lateral to the inferior vena cava (IVC). The gonadal vessels cross anteriorly.

  • At the pelvic brim: passes anterior to the common iliac artery bifurcation.

  • In the pelvis: descends lateral to the internal iliac artery, then courses medially to enter the bladder.

Histology
The ureteral wall consists of three layers:

  • Mucosa: transitional epithelium (urothelium) with lamina propria

  • Muscularis: inner longitudinal and outer circular smooth muscle layers (reversed near bladder) responsible for peristalsis

  • Adventitia: connective tissue containing blood vessels, lymphatics, and nerves

Function

  • Transports urine from the renal pelvis to the urinary bladder via peristaltic contractions and hydrostatic pressure

  • Maintains unidirectional flow due to oblique bladder entry, preventing vesicoureteral reflux

  • Acts as a key component of the upper urinary tract physiology

MRI Appearance

T1-weighted images:

  • Normal ureter wall: low-to-intermediate signal

  • Lumen: usually low signal, but may show variable signal depending on urine composition

T2-weighted images:

  • Urine in ureter lumen: bright hyperintense signal

  • Wall: thin hypointense rim

  • Dilated ureter in obstruction (hydroureter): enlarged hyperintense lumen

STIR:

  • Fat suppression highlights the ureter against surrounding retroperitoneal fat

  • Useful for detecting periureteral edema, inflammation, or tumor spread

T1 Fat-Saturated (Pre-contrast):

  • Ureter wall shows intermediate signal intensity, contrasting against suppressed fat

  • Lumen appears hypointense unless containing proteinaceous material

T1 Fat-Saturated Post-Contrast (Gadolinium):

  • Enhances ureter wall, especially in inflammation, neoplasm, or post-surgical changes

  • Helps evaluate strictures, mural thickening, or urothelial tumors

MRI Non-Contrast 3D Urography:

  • Heavily T2-weighted sequences demonstrate the ureter as a continuous bright tubular structure

  • Ideal for detecting hydronephrosis, hydroureter, or congenital anomalies

CT Appearance

CT Pre-Contrast (Non-contrast CT KUB):

  • Best for detecting ureteric calculi as hyperdense foci within ureter lumen

  • Shows secondary signs: perinephric stranding, ureteral dilatation

CT Post-Contrast (Excretory phase urography):

  • Contrast opacifies ureter lumen, outlining course and patency

  • Detects strictures, filling defects (tumors, clots), or extravasation (trauma, leak)

CT Urography (CTU):

  • Gold standard for ureteral imaging

  • Multiphase acquisition (non-contrast, nephrographic, excretory) shows anatomy, pathology, and function

  • 3D reconstructions highlight course, narrowings, or obstruction

MRI images

Right ureter MRI coronal image anatomy image -img-00000-00000

MRI images

Right ureter MRI sagittal image anatomy image -img-00000-00000

CT image

Right ureter coronal image