Etiology, Characteristics and Management of Ureteric Injury

Experience From a Nationwide Study

Xinfei Li; Kunlin Yang; Guangpu Ding; Xiaofeng Zou; Liefu Ye; Jinfeng Wu; Peng Zhang; Dong Fang; Han Hao; Zhe Li; Hongjian Zhu; Xuesong Li; Haowen Jiang; Kunjie Wang; Liqun Zhou; Hong Li


Transl Androl Urol. 2022;11(6):794-802. 

In This Article

Abstract and Introduction


Background: To investigate the common etiologies, characteristics, and management of ureteric injury.

Methods: A nationwide study was performed in 38 medical centers from Mar 2017 to Mar 2019. The data of patients with ureteric injury were retrospectively collected.

Results: Overall, 294 patients were included in this study. Ten cases (3.4%) were due to abdominal injuries, and 284 cases (96.6%) were due to iatrogenic injuries, including 48.6% from urological procedures, 41.9% from gynecological procedures, 6.3% from general surgery, and 3.2% from other treatments. Most urological injuries (79.7%) were caused by endourological procedures. Injury occurred in the distal ureter in 178 cases (60.5%), the mid-ureter in 31 cases (10.5%), and the proximal ureter in 85 cases (28.9%). Only 51 patients (17.3%) were diagnosed immediately during primary surgery. Immediate ureter reconstruction was performed in 30 patients (58.8%), while delayed urinary diversion was performed in 148 patients (60.9%) in the delayed diagnosis group. The side and the location of the injury were different between the urological and nonurological injury groups (P<0.001). Ureteric injuries were diagnosed timelier in the urological group than in the nonurological group (P=0.037).

Conclusions: Iatrogenic injury was the most common cause of ureteric injury. The majority of iatrogenic injuries were caused by urological procedures and were primarily due to aggressive endourological techniques. Depending on the condition of the patient, the time of diagnosis, and the location and length of the ureteric injury, different management strategies should be applied.


Ureteric injury (UI) is an uncommon condition. UI can be caused by external or iatrogenic factors, and iatrogenic uretic injury (IUI) is the most common cause of UI.[1,2] Due to the anatomical location of the ureter, gynecological, urological, general and other pelvic or abdominal surgeries can result in UI. The majority of IUIs occur during gynecological procedures and in the distal section of the ureter.[1–3] With the development and acceptance of minimally invasive procedures, the frequency and major etiologies of UI have changed.[4–6] The incidence of UI due to urological, gynecological and colorectal surgeries has increased,[7] and the use of endourological and laparoscopic procedures has gradually resulted in an increased number of IUIs.[4,5]

Notably, the clinical signs of UI are often nonspecific, and diagnostic tests are often specific but not sensitive; therefore, UIs are difficult to identify during or after surgery, and the diagnosis may be easily delayed.[3,8] Some UIs may result in intraabdominal or pelvic sepsis, urinary fistulae, renal damage or even death.[9] Thus, timely and effective management provides the best prognosis.[1] The proper method for ureteral repair depends on the location, etiology, extent, and length of the UI.[2] At present, there is no large-scale study of ureteral injury in China. Thus, we performed this multicenter study to summarize the etiologies and general management of UIs. We present the following article in accordance with the STROBE reporting checklist (available at