The loose areolar sheath surrounding the ureter throughout its course, derived from the subperitoneal and retroperitoneal connective tissue.
| Location | Around the ureter along its whole course from the renal pelvis to the bladder |
|---|---|
| Boundaries |
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| Contents |
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Holds the longitudinal blood vessels of the ureter; keeping this sheath intact during surgery protects the ureteric blood supply.
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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