Plexus uretericus – Nerve Network of the Ureter
The plexus uretericus is an autonomic nerve network that supplies the ureter, controlling its movements and pain perception along its entire course.
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The plexus uretericus is an autonomic nerve network that supplies the ureter, controlling its movements and pain perception along its entire course.
What is the Plexus uretericus?
The plexus uretericus (ureteric plexus) is an autonomic nerve network that accompanies and supplies the ureter along its entire course from the renal pelvis to the urinary bladder. It is part of the autonomic nervous system and consists of both sympathetic and parasympathetic nerve fibers. These fibers originate from neighboring nerve plexuses in the abdominal and pelvic regions, most notably the renal plexus (plexus renalis), the abdominal aortic plexus, and the hypogastric plexus.
Anatomy and Course
The ureter travels from the renal pelvis down to the urinary bladder, and the plexus uretericus follows it throughout this entire path. The nerve network lies directly within the adventitia (outer layer) of the ureteral wall, forming a fine meshwork of nerve fibers and small ganglia (nerve nodes). The plexus uretericus can be divided into three segments:
- Upper segment: Supplied by branches of the renal plexus
- Middle segment: Supplied by branches of the abdominal aortic plexus and superior mesenteric plexus
- Lower segment: Supplied by branches of the inferior hypogastric plexus and vesical plexus
Functions
The plexus uretericus fulfills several important roles in regulating ureteral function:
- Motor function: Autonomic nerve fibers influence the smooth muscle of the ureter, regulating peristaltic contractions that propel urine from the renal pelvis toward the bladder.
- Sensory function: Afferent (pain-conducting) nerve fibers transmit pain signals to the central nervous system, for example during a ureteral colic caused by a kidney stone.
- Vasomotor function: The nerve plexus also influences the blood vessels supplying the ureter, helping to regulate local blood flow.
Clinical Relevance
The clinical significance of the plexus uretericus becomes apparent in several medical contexts:
Ureteral Colic
When a kidney stone becomes lodged in the ureter, the plexus uretericus is strongly stimulated by distension and spasm of the ureteral wall. This produces the characteristic, wave-like, extremely intense pain of ureteral colic, which can radiate to the groin, genitals, or inner thigh.
Surgical Relevance
During operations in the retroperitoneal space (behind the peritoneum), such as lymph node dissection or vascular surgery, the plexus uretericus may be inadvertently damaged. Injury to this nerve network can result in impaired ureteral motility.
Referred Pain
Pain signals from the ureter are transmitted via the plexus uretericus to the spinal cord, where they can be projected onto adjacent areas of the body (referred pain). This explains why ureteral pain is often felt in regions such as the groin, testes, or labia, even though the actual source of pain is within the ureter itself.
References
- Standring, S. (Ed.) - Gray's Anatomy: The Anatomical Basis of Clinical Practice. 42nd edition. Elsevier, 2020.
- Drake, R.L., Vogl, A.W. & Mitchell, A.W.M. - Gray's Atlas of Anatomy. 3rd edition. Elsevier, 2019.
- Moore, K.L., Dalley, A.F. & Agur, A.M.R. - Clinically Oriented Anatomy. 8th edition. Wolters Kluwer, 2018.
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