The loose areolar sheath surrounding the ureter throughout its course, derived from the subperitoneal and retroperitoneal connective tissue.
Transmits the ureteric blood supply from the periureteric vascular network and provides the correct plane for ureteric dissection.
The periureteric fascial sheath must be preserved during ureteric mobilisation to maintain the longitudinal periureteric blood supply — stripping the ureter of its fascia devascularises the ureter and risks ureteric necrosis and fistula. This is critical in the "dangerous ureter" scenarios of deep endometriosis, irradiated pelvis, and reoperative surgery.
Excessive ureteric skeletonisation during difficult pelvic dissection disrupting the periureteric blood supply, producing delayed ureteric necrosis and urinary fistula within 1-2 weeks.
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