Surgical dissection (e.g., during hysterectomy, endometriosis excision, or cancer staging).

Accidental clamping, ligation, or transection.

Electrocautery, ultrasonic devices, or lasers used near the ureter.

Prolonged retractor pressure or hematoma formation.

Prior pelvic surgery, radiation, or endometriosis causing adhesions/anatomical distortion.

Large uterine fibroids or ovarian masses displacing ureters.

Congenital anomalies (e.g., duplex ureter).

Radical hysterectomy (e.g., for cervical cancer).

Laparoscopic/robotic surgeries with limited tactile feedback.

Surgeon inexperience.

Visualized ureteral transection or urine leak.

Unexplained fluid in the surgical field.

Flank pain, fever, ileus, or reduced urine output (acute obstruction).

Urinary ascites, vaginal leakage (ureterovaginal fistula), or sepsis.

Elevated serum creatinine (bilateral injury or solitary kidney).

CT urogram: Gold standard for post-op evaluation.

Retrograde pyelogram: Confirms injury location.

IVP/Ultrasound: May show hydronephrosis.

Indigo carmine/cystoscopy to detect urine leakage.

Partial Injury: Double-J stent placement.

Complete Transection:

Percutaneous nephrostomy to relieve obstruction.

Delayed definitive repair after inflammation resolves.

Imaging (e.g., CT/MRI) for high-risk cases to map ureteric course.

Identify ureters at critical steps (e.g., ligating uterine arteries).

Use ureteral stents for visualization in complex cases.

Avoid blind clamping or energy devices near ureters.

Cystoscopy: Post-procedure dye test to confirm ureteral patency.