causes of ureteral trauma

What are the causes of ureteral trauma, and how is it best evaluated?

Iatrogenic injury is the most common cause for ureteral injuries, with gynecologic or other abdominal and pelvic surgeries being the common culprits.

Blunt abdominal trauma, such as by a motor vehicle collision, is an unusual cause for ureteral trauma, but penetrating trauma, such as by gunshot or stab wounds, can injure the ureter.

Computed tomography (CT) acquired in the excretory phase of enhancement is an effective way to assess the ureter for trauma; there is extravasation of contrast material from the injured segment, and there may also be some associated dilation of the affected ureter due to edema at the injury site causing slight obstruction. If ureteral injury is suspected intraoperatively, a retrograde pyelogram can be performed on the operating room table prior to completion of the surgery to assess the ureter for injury.