Grade I (haematoma) -Contusion or Haematoma.
Grade II (laceration) -Less than 50% transection.
Grade III (laceration) -Greater than 50% transection.
Grade IV (laceration) -Complete transection with 2 cm of devascularization.
Grade V (laceration) -Avulsion with greater than 2 cm of devascularization.
Type of Ureteral injuries
Crushing by misapplication of the clamps
Ligation with a suture
Transection ( Partial / complete)
Angulation of the ureter with secondary clips.
Ischaemia from ureteral stripping electro-coagulation.
Resection of a segment of ureter.
Combination of the above.
Incidence of surgical injury
Gynecologic surgery 50 – 66 %
General / Colorectal Surgery 15 – 25 %
Abdominal vascular surgery 5 – 10 %
Ureteroscopy (perforation) 1% - 5 %
Sites of ureteral injuries
usually involves the lower third
Ovarian vascular pedicle at infundibulo-pelvic ligament
Ureteric relation with the uterine artery.
Cardinal ligament, where the ureter crosses under the uterine artery.
Cardinal ligament tunnel, dorsal to the infundibulo -pelvic ligament near or at the pelvic brim.
Lateral rectal pedicles.
Pathological distortion of the ureteral anatomy.
Mode of presentation
Can present post operatively as
- Obstructive uropathy