Ureters

What are ureters?

Ureters (yer-EE-ters or YER-it-ters) are part of your urinary system. They’re narrow, muscle-lined tubes that carry urine (pee) from your kidneys to your urinary bladder. Most people have two ureters.

Sometimes, conditions that may affect your ureters can be uncomfortable or painful, especially when you pee. It can be difficult or even embarrassing to talk about your bathroom habits. But it’s a good idea to talk to a healthcare provider about any symptoms that cause pain or affect how you pee.

What does the ureter do?

Ureters work together with the other parts of your urinary system to remove pee from your body.

After your kidneys make pee, your ureters gently squeeze (contract) in waves to propel or push the pee into your bladder. When your bladder is ready to empty, it contracts, which allows pee to flow through your urethra and out of your body.

Where are the ureters located?

Your left ureter connects to your left kidney, and your right ureter connects to your right kidney. Each ureter connects to one side of the bladder. Your kidneys are just below your ribcage and farther back in your body, while your bladder sits lower in your abdomen and toward the front.

They extend from your abdominal area to your pelvic region. The upper ends of your ureters (proximal ends) connect to the renal pelvis at the center of each kidney. The lower ends (distal ends) connect to your bladder.

What are the parts of the ureters?

Ureters have three layers:

• Outer layer (adventitia). This consists of strong connective tissue and contains nerves, lymph and the ureteral blood supply.
• Middle layer (muscularis). This layer consists of sheets of smooth muscle. The muscles push pee through your ureters into your bladder.
• Inner layer (mucosa). This layer consists of transitional epithelium. It secretes mucus to protect your ureters.

What does it look like?

Ureters are small. In most adults, the ureters are between 10 and 12 inches long (25 and 30 centimeters) and between 0.1 and 0.15 inches (3 and 4 millimeters) in diameter.

What is a ureter problem?

Common conditions or disorders that affect your ureters may include:

• Urinary tract infection (UTI). UTIs can travel up your ureters to your kidneys and cause inflammation (pyelonephritis).
• Ureteral obstruction. A ureteral obstruction blocks one or both of your ureters. Obstruction causes may include an enlarged prostate, scar tissue, blood clot or ureteral stone. They prevent pee from flowing into your bladder. This causes a backflow of pee that can lead to swelling in both kidneys and ureters (hydroureteronephrosis) or just your kidneys (hydronephrosis).
• Ureteral stones. Ureteral stones are a type of urinary stone that forms in your kidneys. They can lodge in your ureter and get stuck if they’re too big. They’re also a type of ureteral obstruction.
• Ureterocele. A ureterocele is a condition that’s present at birth (congenital urinary abnormality). It causes the bottom end of your ureter, which connects to your bladder, to bulge.
• Vesicoureteral reflux (VUR). VUR affects your bladder and ureters. It causes pee to flow back up to your kidneys.
• Ectopic ureter. An ectopic ureter is when your ureter doesn’t connect properly between your kidney and bladder. It’s a condition that’s present at birth.
• Duplex kidney (duplicated ureters). A duplex kidney is a congenital condition in which a kidney has two ureters that connect to your bladder.
• Megaureter. A megaureter is a congenital condition in which your ureter is bigger than usual.
• Ureteral cancer. This is cancer that affects your ureters.

What are common signs or symptoms of ureteral conditions?

Common symptoms of ureteral conditions include:

• Fever
• Nausea and vomiting
• Feeling like you need to pee, but you can’t
• Frequent urination
• Urinary incontinence
• Peeing only a little bit (anuria)
• Cloudy pee
• Foul-smelling pee
• Blood in your pee (hematuria)
• Body pain, including when you pee (dysuria)
• UTIs that go away and come back (recurrent UTIs)
• Abdominal swelling (edema)

Where do ureters hurt?

If you have a ureteral injury or another condition that affects your ureters, you may feel cramping or pain in your:

• Abdominal area
• Pelvic region
• Flank

You may also feel some pain when you pee.

How do you know if your ureter is damaged?

A healthcare provider can determine if you have a condition affecting one or both of your ureters. They’ll generally perform a physical examination and may order the following tests:

• Imaging tests. These may include an ultrasound, CT scan and/or MRI.
• Urinalysis (pee test). Healthcare providers will examine your pee to look for signs of certain conditions.
• Blood tests. Blood tests check for infection and can reveal how well your kidneys work.
• Renal scan. This is a type of nuclear medicine imaging that checks how pee flows in your urinary system.
• Voiding cystourethrogram (VCUG). This is a type of X-ray that traces a special dye through your urinary system.
• Ureteroscopy. A provider uses a long, thin instrument with a lens and a light at the end (ureteroscope) to look through your ureters and other parts of your urinary system.

Can a damaged ureter be fixed?

It depends on what condition affects your ureter. Common treatments for ureter conditions may include:

• Medications, including antibiotics to clear a UTI, an alpha-blocker to relax your prostate gland muscles or finasteride to shrink your prostate
• Ureteral stents to hold your ureters open and allow pee to flow more freely
• Ureteroscopy or shockwave therapy to break up a ureteral stone

Other ureteral conditions may require surgery. They may include:

• Creating a new connection (ureteroureterostomy)
• Attaching the ureter to the correct area in your bladder wall (ureteral reimplantation)
• Creating a new way for pee to leave your body (urinary diversion)
• Removing a blockage or narrow area of your ureter (pyeloplasty)

How do I take care of my ureters?

You can help prevent some conditions that affect your ureters by:

• Drinking lots of water
• Drinking alcohol and caffeine in moderation
• Being physically active
• Reaching and maintaining a weight that’s healthy for you
• Lowering your salt intake
• Limiting the amount of animal proteins in your diet, including meat, eggs and fish
• Avoiding holding your pee
• Preventing UTIs or treating them as soon as possible

What’s the difference between a ureter and a urethra?

Your ureters are tubes that connect your kidneys to your bladder. Your urethra is the tube that runs from your bladder to the outside of your body.