Analyzing relationship between ureter and lumbar vertebrae: insights from digital radiography

In order to mitigate the risk of iatrogenic ureteral injury during surgical procedures, previous research has explored the anatomical relationship between the ureter and the lumbar spine. The primary aim of this study was to elucidate the anatomical relationship between the ureter and the lumbar vertebrae utilizing digital radiography (DR) images.

We retrospectively analyzed anteroposterior DR images of the abdomen from 39 male and 40 female patients with double J ureteral stents. We measured the distance between the stents and the lumbar vertebral body using the superior, middle, and inferior margins of each vertebral body as reference points. The horizontal line from these points to the stent intersection was termed the vertebra-ureter distance, with negative values indicating the ureter was within the vertebral body.

In the sex-based analysis, no significant differences were observed between sexes at any level from L2 to L5. In the laterality-based analysis, no significant differences were identified at levels L2 to L5, except at the inferior level of L5, where measurements on the right side were significantly smaller than those on the left. A gradual decrease in measurements was noted from the L2 to the L5 level. At the L5 level, measurements were zero or negative in 30 out of 237 cases.

In the anterior approach to the lumbar spine, the distal lumbar vertebrae have a closer anatomical relationship with the ureter. Notably, at the L5 level, the right ureter is more susceptible to injury than the left ureter.