Which structure is potentially injured during hysterectomy?

• A. Ureter
• B. Uterine artery
• C. Vagina
• D. Ovary

Answer: (A)

Ureter injury is a key risk in hysterectomy because the ureter travels close to the uterine vessels as it makes its way to the bladder, crossing under the uterine artery near the cervix. When the uterus is removed, the uterine arteries are ligated in the cardinal ligament to control bleeding, and the ureter lies just beneath these vessels. If not carefully identified and protected, the ureter can be accidentally caught in a ligature, cut, or damaged by cautery, leading to obstruction of urine flow downstream ( hydronephrosis or hydroureter). This anatomical relationship is why the ureter is the structure most likely to be injured during the procedure. The uterine artery is intentionally ligated, and injuries to the vagina or ovaries are less characteristic risks of the standard steps in hysterectomy.