Comprehensive Osteopathic Medical Licensing Examination (COMLEX USA) Practice

Which vertebral levels are associated with the ureters?

1. T10-L1

2. L1-L2

3. T12

4. T8-T10

The correct answer is: T10-L1

The correct answer indicates that the ureters are associated with the vertebral levels from T10 to L1. This range reflects the anatomical course of the ureters as they travel from their origin at the renal pelvis in the kidneys down to the bladder. The ureters begin at the hilum of each kidney, which is located at approximately the L1 level, and then they move downwards and laterally to cross over the pelvic brim, which occurs at the T10 level. This anatomical association is significant, as it aids in understanding the referred pain patterns and potential injury sites related to abdominal and urinary pathologies. Understanding the primary nerve supply to the ureters is also tied to these levels. The sympathetic innervation arises from the thoracolumbar region (T10-L1) of the spinal cord. This correlates with the pain pathways that can be engaged in conditions affecting the ureters, such as kidney stones or infections, which often present with referred pain to the T10-L1 dermatomes. In contrast, the other vertebral levels mentioned do not encompass the full anatomical trajectory of the ureters, and thus do not accurately represent where they are located.