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Ureteral Trauma - Emergency Management

General Information

General InformationGeneral Information


  • External trauma causes 20% of ureteral injuries, the rest occurs intraoperatively1


  • The ureters are retroperitoneal structures1
  • Proximally protected by the psoas muscles and vertebral column, distally protected by the pelvis


  • Most ureteral injuries occur in the operating room (80%)1, often from gynecologic surgery
  • Of those occurring outside of the operating room, 60% are due to penetrating trauma2
    • Gunshot wounds (GSWs) are the most common cause
  • Blunt trauma
    • significant deceleration forces are required (motor vehicle collisions [MVC] or a fall from height)
    • injury typically occurs where ureters are fixed at ureteropelvic or ureterovesicular junctions1


  • Uncommon: 3/10,000 trauma hospitalizations2
    • Least common cause of genitourinary trauma is due to small size and location3
  • 84% of patients with ureteral trauma are male2
  • Ureteral injuries are identified in 3% of abdominal gunshot wounds (GSWs)4,5



General references used

  1. Elliott SP, McAninch JW. Ureteral injuries: external and iatrogenic. Urol Clin North Am. 2006 Feb;33(1):55-66
  2. Siram SM, Gerald SZ, Greene WR, et al. Ureteral trauma: patterns and mechanisms of injury of an uncommon condition. Am J Surg. 2010 Apr;199(4):566-70
  3. Bryk DJ, Zhao LC. Guideline of guidelines: a review of urological trauma guidelines. BJU Int. 2016 Feb;117(2):226-34full-text
  4. Elliott SP, McAninch JW. Ureteral injuries from external violence: the 25-year experience at San Francisco General Hospital. J Urol. 2003 Oct;170(4 Pt 1):1213-6
  5. McGeady JB, Breyer BN. Current epidemiology of genitourinary trauma. Urol Clin North Am. 2013 Aug;40(3):323-34full-text
  6. Jankowski JT, Spirnak JP. Current recommendations for imaging in the management of urologic traumas. Urol Clin North Am. 2006 Aug;33(3):365-76
  7. Engel O, Rink M, Fisch M. Management of iatrogenic ureteral injury and techniques for ureteral reconstruction. Curr Opin Urol. 2015 Jul;25(4):331-5
  8. Tezval H, Tezval M, von Klot C, et al. Urinary tract injuries in patients with multiple trauma. World J Urol. 2007 Apr;25(2):177-84

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How to cite

National Library of Medicine, or "Vancouver style" (International Committee of Medical Journal Editors):

  • DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T909736, Ureteral Trauma - Emergency Management; [updated 2018 Nov 30, cited place cited date here]. Available from Registration and login required.

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EBSCO Information Services accepts no liability for advice or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional.


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