Iatrogenic and Traumatic Ureteral Injury

Abstract

Ureteral injuries result from either iatrogenic or external trauma. Iatrogenic ureteral injuries far outnumber traumatic injuries. Ureteroscopy currently accounts for the majority of iatrogenic ureteral injuries. However, most of these injuries are minor and managed with JJ stent. Open pelvic surgery, particularly gynecological procedures, account for the majority of open surgical injuries to the ureter. It is estimated that ureteral injuries occur in 0.5-1% of pelvic surgery. Other abdominal surgical procedures that can result in ureteral injury include colectomy, appendectomy, aorto-iliac bypass, and urological surgeries such as ureteral reimplantation and ureterolithotomy. Many ureteral injuries can be repaired endoscopically with a combination of internal ureteral stenting and percutaneous nephrostomy tube drainage. The rest are amenable to a variety of open surgical techniques depending on the level of injury. Ureteral injuries as a result of external trauma are uncommon, are mostly the result of penetrating gunshot wounds, and are almost always associated with multiple organ injuries.