I900 HUMAN ANATOMY. 



ureter will be most readily felt. The examination should be made very gently, and 

 the finger should be passed comparatively lightly over, not pressed firmly against, 

 the vaginal surface. The ureter courses about midway between the cervix uteri and 

 the wall of the pelvis, and by hard pressure the ureter is displaced before the finger 

 in a direction towards the pelvic wall. The uterine artery or the muscular fibres of 

 the obturator internus or levator ani (Sanger) should not be mistaken for the ureter. 



(d) Rectal Palpation. — The lower extremity of the ureter, when occupied by a 

 foreign body or in a state of disease, can be felt through the rectum in the male, but 

 less readily than through the vagina in the female. A calculus impacted in the lower 

 end of the ureter has been located and removed through the rectum. It is through 

 the antero-lateral wall of the bowel and a little higher than the level of the base of the 

 vesicula seminalis that we feel for the ureter. The pulp of the finger should be 

 directed towards the back of the bladder and pushed as far as possible beyond the 

 upper edge of the prostate ; afterwards the finger-pulp should be turned towards the 

 lateral wall of the pelvis, and whilst still pushed as far as possible, it should traverse 

 the wall of the rectum forward and backward. The examination is difficult, and if 

 the prostate is much enlarged the detection of the ureter is impossible. The normal 

 ureter is not likely to be distinguished, even if the perineum be thin and the prostate 

 normal. 



(<r) Vesical palpation — through the dilated urethra of the female — may disclose 

 dilatation, oedema, prolapse, or infiltration, inflammatory or tuberculous, of the 

 vesical end or orifice of the ureter, or may reveal the presence of an impacted 

 calculus. 



Woufids or subparietal injuries of the ureter, unassociated with other intra- 

 abdominal lesions, are rarer than similar injuries of the kidney, decrease in frequency 

 from above downward, and, on account of the bony protection afforded it, are very 

 uncommon in the pelvic portion of the ureter. 



The upper portion may be crushed against the transverse process of the first 

 lumbar vertebra (Tuffier), or so stretched as to tear or sever it (Fenger). 



Unless the escape of urine from an external wound occurs, the symptoms are 

 merely those of ureteral irritation, usually with slight transient haematuria and the 

 evidence of slow urinary extravasation superadded. 



After extraperitoneal rupture or wound the swelling due to extravasated urine 

 and subsequent cellulitis might be recognized in the loin or detected by rectal or 

 vaginal examination in the pelvis. Longitudinal wounds gape less (and therefore 

 heal more readily) than transverse wounds, on account of the longitudinal disposition 

 of the thicker internal layer of muscular fibres. 



Tiunors of the ureters are almost unknown as primary conditions, but consider- 

 ation of the relations of the ureter (page 1895) ^^"^ show that it may be pressed upon 

 by growths or involved in inflammatory processes originating in the caecum or in the 

 ascending or descending colon. Its pelvic portion is more exposed to pressure than 

 is the abdominal on account of the counter-resistance of the pelvic walls, and here it 

 may be compressed by fecal masses in the sigmoid or rectum, by iliac aneurism, or 

 by growths of the uterus, ovary, or Fallopian tube, or may become involved in dis- 

 ease of the appendix when it occupies a pelvic position, or of the bladder or seminal 

 vesicles. 



The tough, resistant character of the walls of the tube, the laxity of the con- 

 nective tissue in which it lies, the layer of loose fat that, in part of its course, 

 surrounds and protects it in well-nourished individuals (Luschka), and its rich vas- 

 cular supply (from the renal, spermatic or ovarian, and vesical arteries) enable it to 

 resist or avoid injury or to undergo speedy repair. It is thus possible to separate it 

 extensively from surrounding structures during operations with little or no risk of 

 necrosis. 



The oblique course of the ureter through the vesical wall subjects it to pressure 

 when the bladder contracts, or when it becomes rigid from arterio-sclerotic disease. 

 Frequencv of urination alone has been thought competent — by the constantly recur- 

 ring obstruction to the entrance of urine into the bladder — to produce ureteral dila- 

 tation and hydronephrosis. As its obliquity leaves it on the inner aspect covered by 

 mucous membrane only, and as the outer aspect is covered by the muscular layer of 



