Ureteric Injury Management

What is Ureteric Injury Management?

Ureteric injury management refers to the diagnosis and treatment of damage to one or both ureters, the tubes that carry urine from the kidneys to the bladder. Although uncommon, ureteric injuries most often occur as a complication of pelvic or abdominal surgery, trauma, or, less frequently, severe inflammation or cancer.

Prompt recognition and treatment are essential to restore the normal flow of urine, preserve kidney function, and prevent complications such as infection, urine leakage, or permanent kidney damage. Management may involve temporary drainage procedures, minimally invasive techniques, or reconstructive surgery, depending on the location and severity of the injury.

What are the Benefits of Ureteric Injury Management?

Early and appropriate treatment helps prevent long-term complications and protects kidney health.

Benefits include:

• Restores normal urine drainage
• Preserves kidney function
• Prevents urine leakage into surrounding tissues
• Reduces the risk of infection
• Relieves pain caused by urinary obstruction
• Minimises the risk of permanent kidney damage
• Provides long-term reconstruction when required
• Can often be performed using minimally invasive techniques where appropriate

When is Ureteric Injury Management Recommended?

Treatment is recommended whenever a ureter has been injured or its function has been significantly impaired.

Common indications include:

• Injury during gynaecological, colorectal, vascular, or urological surgery
• Trauma to the abdomen or pelvis
• Ureteric transection or partial tear
• Thermal injury during surgery
• Accidental ligation or clipping of the ureter
• Urine leakage following surgery
• Ureteric obstruction caused by scar tissue after injury
• Delayed diagnosis of a postoperative ureteric injury

The type of treatment depends on how quickly the injury is recognised, its location, and the extent of the damage.

What does Preparation for Ureteric Injury Management Involve?

Before treatment, your urologist will determine the location and severity of the injury and assess kidney function.

Preparation may include:

• Medical history and physical examination
• Blood tests, including kidney function
• Urine tests and urine culture
• CT urogram or CT scan with contrast
• Ultrasound of the kidneys
• Retrograde pyelogram or antegrade pyelogram
• Cystoscopy or ureteroscopy where appropriate
• Review of current medications
• Discussion of the planned treatment and expected recovery

If infection or urinary obstruction is present, temporary drainage may be performed before definitive reconstruction.

How is Ureteric Injury Management Performed?

The treatment of a ureteric injury depends on the severity, location, and timing of the diagnosis.

Small injuries or partial tears identified early may be treated by inserting a ureteric stent through a cystoscope. The stent bridges the injured area, allowing urine to drain freely while the ureter heals.

If the injury is more extensive, reconstructive surgery is usually required. The damaged portion of the ureter may be removed, and the healthy ends rejoined in a procedure known as a ureteroureterostomy. When the lower ureter is affected, the ureter is commonly reimplanted into the bladder using a ureteric reimplantation procedure. If additional length is needed, techniques such as a psoas hitch or Boari flap may be used to allow a tension-free repair.

For complex or extensive injuries involving a large section of the ureter, more advanced reconstructive procedures, including bowel interposition or kidney repositioning, may occasionally be required.

Temporary ureteric stents, urinary catheters, or nephrostomy tubes are frequently used to support healing and maintain urine drainage following reconstruction. Many reconstructive procedures can now be performed using laparoscopic or robotic-assisted techniques in suitable patients.

What to Expect during Recovery after Ureteric Injury Management?

Recovery depends on the type of treatment performed and the severity of the original injury.

Following treatment, patients may experience:

• A hospital stay ranging from one day to several days
• Temporary urinary catheter drainage
• A ureteric stent that remains in place for several weeks
• Mild abdominal or flank discomfort
• Temporary blood in the urine
• Gradual return to normal activities over several weeks
• Follow-up imaging to confirm successful healing and unobstructed urine flow

Most patients make a good recovery, although regular follow-up is important to ensure the repaired ureter continues to function normally.

What are the Risks and Complications of Ureteric Injury Management?

Although treatment is generally successful, all procedures carry some potential risks.

Possible complications include:

• Bleeding
• Infection
• Urinary tract infection
• Leakage from the repair site
• Narrowing of the ureter during healing (ureteric stricture)
• Persistent urinary obstruction
• Stent-related discomfort
• Injury to surrounding organs or blood vessels
• Reduced kidney function if treatment is delayed
• Need for additional reconstructive surgery
• Anaesthetic-related complications

Your urologist will explain the most appropriate treatment for your ureteric injury, discuss the expected benefits and potential risks, and develop a personalised follow-up plan to monitor healing and protect your long-term kidney function.