National Society of Pediatric Surgery of the Republic of Moldova
Abstract
The micro-anatomical structural and morpho-functional capacity of the ureter from the lumen to the exterior, depending
on the predominant tissue component, is determined and guided by three tunics: the internal tunic - the epithelial conjunctive, the medial tunic - the muscular conjunctive and the external conjunctive-vascular-nervous. The latter has a significant
importance in the medical-surgical management of surgical pathology and functional management of the intraoperative
and postoperative ureter. This is frequently found in both normal ureters and ureteral malformations due to the well-differentiated vasculo-arterial afferent network associated with efferent vascular-venous networks.
The conjunctive-vascular-nervous tunic, so nominated by us, is constituted by making continuously the connective
tissue from the muscular-conjunctive tunic to the periphery and transition by discontinuity of the connective tissue of the
retroperitoneal cell-adipose tissue into a lax connective plate consisting of fine collagen and elastic fibers with a varied condensation, thus anchoring the ureter in the retroperitoneal space. We consider it the “meso” of the ureter
Normally, this tunic has a more intimate appearance with the ureter, whereas a considerable distance from the muscular
tunic can be observed in malformations.
It has been established that vasculo-nervous devices in the sheath area form a vascular plexus giving various circular and
longitudinal oblique branches anastomosed and organized in a layered way, segmented or in various arborescent aspects.
This plexus, a vascular carcass, directly communicates with the vasculo-nervous network of muscle and epithelial-connective tunics. Between the sheath and ureter muscles, the connective tissue is devoid of vascular anastomosis, in this area
there are only afferent and efferent arterio-venous vessels that penetrate the respective area, which allows it to be detached
on insignificant surfaces.
The detachment of the ureteral sheath induces amputation of the afferent and efferent arterial and venous branches
with the disordered local circulation at the meso-ureter level, including the ureter within the limits of the detachment. The
attempts of detachment of the ureteral sheath contribute to severe circulatory disturbances in the ureteral segments meant
for anastomosis, which leads to fibrosis of the ureter.
The lower third of the ureter does not mobilize, but detaches from the peri