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Ureteral injuries are rare but can occur during surgical procedures, abdominal trauma, kidney stones, fibrosis, and cancer. Gynecological, colorectal, and vascular surgeries are common causes, as well as endoscopic procedures and radiation treatments.
Injuries to the ureters, or the tubes that connect the kidneys to the bladder, are quite rare as the structures are well protected within the body, but there are some situations that can damage them. Probably the most common is when unintentional ureteral injury occurs during surgical procedures inside the abdomen, such as colorectal surgery or hysterectomies. They can also be the result of abdominal trauma, especially with wounds such as gunshot or stab wounds that go inside. Kidney stones that pass through the ureters can also damage them, as can some other diseases such as fibrosis and cancer.
The most frequent reason for people to have ureteral injuries is when surgery on nearby tissues damages them. Gynecological procedures, especially hysterectomies, are often responsible. Colorectal and vascular surgeries in the abdomen can also lead to unintentional ureteral damage. They can also be the result of procedures performed on the urological system, such as endoscopic surgeries that involve inserting instruments into the ureter itself, as well as surgical removal of tumors and sometimes radiation treatments.
Another potential cause of ureteral injury is external trauma. While it’s possible for blunt trauma to the abdomen, such as a blow or fall, to injure the ureters, it’s quite unlikely. Much more often, the cause of ureteral damage is an injury that penetrates the abdominal cavity and causes a perforation or puncture of the structures, such as a knife or gunshot wound.
Kidney stones can also be a source of ureteral injury. As these stones move from the kidneys to the ureters, they can lodge in the passageways and block the flow of urine, which has the potential to damage both structures. Gemstones can also cause bruising or inflammation as they pass through the tubes. Also, if an endoscopic procedure is needed to remove the stone or place a stent to aid urine drainage, the risk of injury is even greater.
Ureteral injuries can also occur due to diseases. Retroperitoneal fibrosis can cause tissue to build up in the abdomen which can then put pressure on the ureters. Cancerous tumors within the abdominal cavity can also push them. This can become especially problematic for the ureters if the cancer spreads to nearby lymph nodes. In addition to any problems caused by the cancer itself, cancer treatments — surgery, radiation, and chemotherapy — can lead to further ureteral injury.
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