Ureter Injury
Damage to a tube that carries urine from the kidney to the bladder
Quick Facts
- Type: Urologic injury
- Common causes: Pelvic/abdominal surgery, trauma
- Possible signs: Flank pain, fever, urine leakage
- Treatment: Stent, drainage, or surgical repair
Overview
The ureters are two narrow tubes that carry urine from the kidneys down to the bladder. A ureter injury is damage to one of these tubes, which can cause urine to leak inside the body or block urine flow from the kidney. Because the ureters are deep in the abdomen and pelvis and lie close to many organs, they are most often injured during surgery in this area.
Ureter injuries can be subtle and may not cause symptoms right away, so they are sometimes recognized only days after the original event. Prompt diagnosis is important, because untreated injuries can harm the kidney or lead to infection.
Symptoms
Symptoms depend on whether the ureter is blocked, leaking, or both, and they may be delayed. Possible signs include:
- Pain in the flank or side, where the kidney sits
- Lower abdominal or pelvic pain
- Blood in the urine
- Fever and feeling unwell if infection develops
- Leakage of urine from a wound or, in some cases, the vagina
- Reduced urine output if both ureters or a single kidney are affected
Fever, worsening flank pain, or signs of infection after pelvic surgery or trauma should prompt urgent evaluation.
Causes
Ureter injuries arise mainly from medical procedures and trauma. Common causes include:
- Pelvic and abdominal surgery: The ureters can be cut, tied, crushed, or burned during operations on the uterus, ovaries, bowel, or bladder.
- Endoscopic procedures: Instruments used to treat kidney stones can occasionally injure the ureter.
- Penetrating trauma: Stab or gunshot wounds.
- Blunt trauma: Less common, as the ureters are well protected, but possible in severe injuries.
Because the ureters are small and run close to other structures, gynecologic and colorectal surgeries are among the more common settings for accidental injury.
Risk Factors
- Complex pelvic or abdominal surgery
- Previous surgery, scarring, or pelvic radiation
- Large pelvic masses or distorted anatomy
- Procedures to treat kidney or ureteral stones
- Penetrating abdominal trauma
Diagnosis
If a ureter injury is suspected during or after a procedure, evaluation may include:
- CT urogram: A scan with contrast dye that shows the kidneys and ureters and can reveal a leak or blockage.
- Retrograde pyelogram: Contrast dye placed into the ureter during a scope procedure to outline its course.
- Ultrasound: Can show swelling of the kidney from a blockage.
- Fluid analysis: Testing drainage fluid for high creatinine levels, which suggests it is urine.
Recognizing an injury during the original surgery allows immediate repair, while delayed injuries are diagnosed using these imaging tests.
Treatment
Treatment depends on the location, severity, and timing of the injury.
- Ureteral stent: A thin tube placed inside the ureter to keep it open and let a minor injury heal.
- Drainage: A tube placed through the back into the kidney (nephrostomy) can divert urine and relieve a blockage.
- Surgical repair: Cuts or more serious damage are repaired by reconnecting the ureter or reimplanting it into the bladder, sometimes using nearby tissue.
- Treating complications: Antibiotics for infection and care for any associated injuries.
With timely treatment, most ureter injuries heal well and kidney function is preserved.
Prevention
- Careful surgical technique and identification of the ureters during pelvic surgery
- Imaging or stents before complex operations when anatomy is distorted
- Prompt evaluation of unexpected symptoms after surgery
- Wearing protective equipment and seatbelts to reduce trauma
When to See a Doctor
Contact your care team promptly after pelvic or abdominal surgery or trauma if you develop:
- Worsening flank, side, or abdominal pain
- Fever, chills, or feeling increasingly unwell
- Leakage of clear fluid from a wound or the vagina
- Blood in the urine or a drop in how much you urinate
Seek emergency care if you have a high fever with severe pain or signs of serious infection, as a blocked or leaking ureter combined with infection can become dangerous and needs urgent treatment.
Frequently Asked Questions
How does a ureter get injured?
Most ureter injuries happen during pelvic or abdominal surgery, when the tube can be cut, tied, crushed, or burned. They can also occur during procedures for kidney stones or from penetrating trauma such as stab or gunshot wounds.
Why might a ureter injury be discovered late?
Ureter injuries can cause few symptoms at first. Pain, fever, urine leakage, or a blocked kidney may appear days after surgery, which is why new symptoms during recovery should be evaluated promptly.
How is a ureter injury treated?
Minor injuries may heal with a stent placed inside the ureter or a drainage tube into the kidney. More serious damage usually needs surgery to repair or reconnect the ureter. Infection is treated with antibiotics.
Will my kidney be harmed by a ureter injury?
If treated promptly, most ureter injuries heal well and kidney function is preserved. A long-standing blockage or untreated injury can damage the kidney, which is why early diagnosis matters.
When should I seek urgent care?
Get prompt care for worsening flank or abdominal pain, fever, clear fluid leaking from a wound, or reduced urination after surgery or trauma. A high fever with severe pain may signal serious infection and needs emergency care.
References
- Urology Care Foundation, American Urological Association. Ureteral Trauma.
- Mayo Clinic. Surgical and traumatic urinary injuries.
- MedlinePlus, U.S. National Library of Medicine. Ureteral injury.
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Urinary tract injuries.