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Ureteral RuptureMANAGEMENT

GENITOURINARY AND REPRODUCTIVE PRESENTATIONS · 12 SECTIONS

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751 items

☷ Legend

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Cardiovascular Presentations71▾

Respiratory Presentations52▾

Neurological Presentations83▾

Gastrointestinal Presentations74▾

Genitourinary and Reproductive Presentations48▾

Acute Kidney Injury (ATN)Acute Kidney Injury (Post-renal)Acute Kidney Injury (Pre-renal)Amniotic Fluid Embolism Balanitis Bladder Rupture Breast Abscess Cystitis Dialysis access complications Ectopic pregnancy Epididymitis Glomerulonephritis Hematuria (gross)Hydrocele Interstitial Cystitis Mastitis Mittelschmerz Nephrolithiasis Nephrotic Syndrome Flare Nutcracker Syndrome Orchitis Ovarian Cyst Rupture Ovarian hyperstimulation syndrome Ovarian torsion Paraphimosis Pelvic Congestion Syndrome Pelvic Inflammatory Disease (PID)Peritoneal dialysis peritonitis Phimosis Priapism Prostatitis Pyelonephritis Renal laceration Renal transplant complications and rejection Ruptured ovarian cyst Testicular torsion Torsion of Appendix Testis Tubo-ovarian abscess Ureteral Rupture Urethritis Urinary Retention Urinary tract infection (uncomplicated)Urolithiasis (renal colic)Vaginal bleeding (non-pregnant)Vaginitis (Bacterial)Vaginitis (Candidal)Varicocele Vulvovaginal Hematoma

Infectious Disease Presentations148▾

Trauma Presentations89▾

Toxicologic Presentations80▾

Psychiatric Presentations26▾

Musculoskeletal and Rheumatologic Presentations96▾

Dermatology Presentations23▾

Environmental and Exposure Presentations27▾

Hematologic and Oncologic Presentations36▾

Pediatric-Specific Presentations19▾

Endocrine and Metabolic Presentations45▾

ENT and Maxillofacial Presentations27▾

Ophthalmologic Presentations19▾

Obstetric Presentations23▾

Systemic and Miscellaneous Presentations17▾

01Approach to the Critical Patient/attcp57

Immediate priorities

›Airway, breathing, and circulation in polytrauma

›IV access and volume resuscitation

›Two large-bore IVs or IO access

›Crystalloid bolus for hemorrhagic shock

›Hemodynamic instability triggers

›SBP < 90 mmHg

›HR > 120 bpm with hypotension

›If hemodynamically unstable with penetrating abdominal trauma, immediate surgical consultation

›Damage control approach

›Defer definitive ureteral repair to second-look surgery

›Urology consultation triggers

›All confirmed or suspected ureteral injuries

›Mandatory regardless of mechanism

›Early engagement improves outcomes

›Rising creatinine post abdominal/pelvic surgery

›Delayed presentation of iatrogenic injury

›Retrograde pyelography planning

Recognition and key branching

›High-suspicion scenarios

›Penetrating abdominal or flank trauma

›GSW trajectory near retroperitoneum

›Stab wound to flank

›High-energy blunt deceleration

›MVC, fall from height

›Ureteropelvic junction avulsion risk

›Recent pelvic or abdominal surgery

›Gynecologic, colorectal, or urologic procedures

02History/hx76

Mechanism and presentation

›Traumatic mechanisms

›Penetrating trauma

›GSW to abdomen, flank, or pelvis

›Stab wound trajectory

›Blunt high-energy deceleration

›MVC with rapid deceleration

›Fall from significant height

›Iatrogenic

›Gynecologic surgery (hysterectomy most common)

›Colorectal surgery (left hemicolectomy, rectal resection)

›Ureteroscopy or ureteral instrumentation

›Spontaneous rupture history

›Prior nephrolithiasis or obstructing calculus

›56% of spontaneous rupture cases

›Ureteral stricture in 17%

›Sudden severe flank or abdominal pain

›No trauma history

›Possible prior ureteral tumor

Symptoms

›Pain characteristics

›Flank pain

›Onset and severity

›Radiation to groin or lower abdomen

›Abdominal pain or distension

›May indicate urinoma formation

›Peritoneal irritation from urinary extravasation

›Urinary symptoms

03Physical Exam/exam55

Vitals and general

›Hemodynamic stability assessment

›Blood pressure

›SBP < 90 mmHg indicates shock

›MAP < 65 mmHg as critical threshold

›Heart rate

›Tachycardia with hypotension

›Reflex tachycardia with pain

›Temperature

›Fever suggests urinoma, abscess, or urosepsis

›Hypothermia as severe sepsis marker

›Urine output

›Via Foley catheter

›Hematuria or oliguria noted

Abdominal and flank exam

›Abdominal findings

›Flank tenderness

›Ipsilateral costovertebral angle tenderness

›Percussion tenderness

›Peritoneal signs

›Guarding and rigidity

›Rebound tenderness

›Abdominal distension

›Urinoma or ileus

›Retroperitoneal hemorrhage

›Flank and back inspection

›Ecchymosis (Grey Turner sign)

›Retroperitoneal hemorrhage marker

04Differential Diagnosis/ddx42

Life-threatening diagnoses

›Immediate threats

›Renal vascular pedicle injury

›ICD-10 S37.04 associated

›Non-enhancing kidney on CT

›Retroperitoneal hemorrhage from vascular injury

›Expanding hematoma

›Hemodynamic instability

›Aortic dissection or ruptured AAA

›ICD-10 I71 spectrum

›Flank pain with hemodynamic collapse

›Bladder rupture

›ICD-10 S37.20 series

›Pelvic fracture association

›CT cystogram diagnostic

Urologic mimics

›Renal colic and nephrolithiasis

›ICD-10 N20.1 ureteral calculus

›Most common mimic of spontaneous ureteral rupture

›Distinguished by CT showing calculus vs contrast extravasation

›Renal laceration or contusion

›ICD-10 S37.00 series

›Associated with blunt trauma

›CT distinguishes from ureteral injury

›Urinoma or abscess

›Delayed presentation of missed injury

›Fever, flank mass, rising creatinine

›ICD-10 N28.89 associated

05Laboratory Tests/lt46

Core trauma and injury labs

›Urinalysis

›Hematuria (gross or microscopic)

›Absent in up to 55% of ureteral injuries

›Presence supports but absence does not exclude

›Pyuria

›Infection complication

›Urosepsis concern

›Complete blood count

›Hemoglobin and hematocrit

›Hemorrhage assessment in polytrauma

›Serial trending if active bleeding

›White blood cell count

›Leukocytosis with infection

›Leukopenia as severe sepsis marker

›Metabolic panel

›Creatinine (baseline renal function)

›Rising creatinine suggests urinoma or obstruction

›Solitary kidney or CKD raises threshold for intervention

›BUN and electrolytes

›Antibiotic dosing adjustment

›Volume status assessment

›Glucose

›Hyperglycemia as stress response marker

Perfusion and infection

›Lactate

›Tissue perfusion in trauma and sepsis

›>= 2 mmol/l as organ hypoperfusion marker

06Diagnostic Tests/dt97

Scoring Systems

›AAST Ureteral Organ Injury Scale (Grades I to V)

›Grade I: contusion or hematoma without devascularization

›Conservative or minimally invasive management

›Observation with stenting may suffice

›Grade II: laceration < 50% circumference

›Retrograde stenting typically effective

›Primary repair if discovered intraoperatively

›Grade III: laceration >= 50% circumference

›Surgical repair over double-J stent

›Partial vs complete transection distinction

›Grade IV: complete transection < 2 cm devascularization

›Ureteroureterostomy (proximal) or ureteroneocystostomy (distal)

›Stent placement after repair

›Grade V: complete transection > 2 cm devascularization

›Complex reconstruction required

›Psoas hitch or Boari flap if distal

›Damage control then delayed repair if unstable

›Clinical injury classification framework

›Location-based classification

›Proximal (above iliac vessels): ureteroureterostomy preferred

›Distal (below iliac vessels): ureteroneocystostomy preferred

›Timing classification

›Immediate repair (< 1 week): success rate 78%

›Delayed repair: success rate 61%

MRI

›MRI abdomen/pelvis role in ureteral rupture

›Primary alternative when CT contrast contraindicated

›Iodine allergy

›Severe renal impairment preventing contrast use

›Preferred modality in pregnancy

›Avoids ionizing radiation

›MRI urography sequences for collecting system

›Problem-solving indications

›Suspected underlying ureteral tumor

›Complex retroperitoneal anatomy

›Urinoma or abscess characterization

›MRI findings

›Fluid collections in retroperitoneum

›Urinoma vs hematoma differentiation

›Signal characteristics guide tissue type

›Ureteral wall edema or disruption

›Limitations

›Not first-line in acute trauma

›Availability and time constraints

›Patient cooperation required

›CT abdomen/pelvis with IV contrast

›First-line imaging for hemodynamically stable patients

›Gold standard per ACS and WSES-AAST guidelines

›Sensitivity 93%, specificity 100% for collecting system injury with excretory phase

›Required protocol: delayed (excretory) phase at 10 minutes

›Early portal venous phase alone inadequate

›Excretory phase shows contrast extravasation and ureteral opacification

›Key CT findings

›Contrast extravasation from ureter

›Periureteral fluid or hematoma

›Hydronephrosis proximal to injury

›Delayed nephrogram on affected side

›Lack of distal ureteral opacification

›Associated injury evaluation

›Concomitant bowel injury

›Vascular injury or retroperitoneal hematoma

›Solid organ injury

›Contrast precautions

›Renal function assessment prior to contrast

›Hold metformin

›Hydration protocol if impaired function

›Allergy history

›Premedication protocol for prior reactions

›IVP / intravenous pyelogram

›Largely replaced by CT

›False-negative rate up to 60%

›One-shot IVP in unstable trauma bay patients only

›Retrograde pyelogram (RPG)

›Most accurate test for location and extent of injury

›Used when CT equivocal

›Requires urologist and fluoroscopy

›Defines injury level precisely for surgical planning

›Guides stent length selection

›Identifies complete vs partial disruption

Ultrasound

›Ultrasound in ureteral rupture

›Limited role in acute ureteral injury diagnosis

›Cannot reliably identify contrast extravasation

›WSES-AAST guidelines state no primary role in acute diagnosis

›Adjunct applications

›Hydronephrosis detection proximal to obstruction or injury

›Urinoma or retroperitoneal fluid collection identification

›Follow-up imaging after stent placement

›FAST exam in trauma

›Free fluid in abdomen and pelvis

›Not specific for ureteral injury

›Guides resuscitation decisions

›Follow-up ultrasound

›Post-stent placement at 4 to 6 weeks

›Assess for residual hydronephrosis

›Identify developing stricture

›Urinoma resolution monitoring

›Serial size assessment

›Infection surveillance

07Disposition/dispo43

Admission and operative criteria

›All confirmed ureteral ruptures require admission

›Monitoring for complications

›Urinoma formation

›Urosepsis

›Surgical planning or postoperative care

›Urology coordination required

›ICU-level care indications

›Hemodynamically unstable polytrauma

›Vasopressor requirement

›Active hemorrhage management

›Septic shock from urinoma or abscess

›Broad-spectrum antibiotics initiated

›Drainage procedure required

›Bilateral ureteral injury or solitary kidney

›Renal replacement therapy planning if needed

Consultation requirements

›Urology consultation

›Mandatory for all confirmed or suspected ureteral injuries

›ACEP Level C recommendation

›Early engagement improves outcomes

›Retrograde stenting or surgical repair decision

›Grade guides procedure choice

›Timing: immediate vs delayed

›Trauma surgery

›For associated injuries in penetrating or blunt trauma

›Bowel injury co-management

›Vascular injury management

08Treatment/t104

Initial stabilization

›Resuscitation in trauma

›IV fluid and hemorrhage control per ATLS protocol

›1 L crystalloid bolus if hemodynamically unstable

›Massive transfusion protocol if refractory shock

›Foley catheter placement

›Urine output monitoring target > 0.5 ml/kg/hour

›Document hematuria and color

›NPO if surgical intervention anticipated

›Anesthesia notification for timing

›Antibiotics when infection present

›Broad-spectrum IV coverage for urinoma, abscess, or sepsis

›Piperacillin-tazobactam 4.5 g IV every 6 hours

›Alternative ceftriaxone 2 g IV daily plus metronidazole 500 mg IV every 8 hours

›Adjust based on culture results

›De-escalate when sensitivities available

›Duration guided by source control adequacy

›Analgesia

›IV opioids for severe pain in trauma

›Morphine 2 to 4 mg IV every 4 hours PRN

›Fentanyl 1 mcg/kg IV for procedural pain

›Ketorolac IV for spontaneous rupture pain if renal function intact

›15 to 30 mg IV every 6 hours

›Avoid if creatinine elevated or surgery imminent

Minimally invasive management

›Retrograde double-J ureteral stent

›Indications

›Partial transection (AAST Grade I to II)

›Spontaneous ureteral rupture (72% of cases managed this way)

›Postoperative iatrogenic injury if detected early

›Stent duration

›Average 21 days for spontaneous rupture

›3 to 6 weeks for traumatic partial injury

›Success rate for partial injuries

›Approximately 89% with appropriate stenting

›Procedure details

›Cystoscopic placement under fluoroscopic guidance

›Urologist required

›General or spinal anesthesia often needed

›Percutaneous nephrostomy

›Indications

›Retrograde stenting failed or not feasible

›Obstructed, infected system (urosepsis)

›Bridging to delayed surgical repair

›Provides decompression and urinary diversion

›Interventional radiology performed

›Antegrade pyelography possible via nephrostomy

Surgical repair - distal ureteral injuries

›Ureteroneocystostomy (ureteral reimplantation)

›Preferred for injuries distal to iliac vessels

›Grades III to V distal location

›Success rate 91 to 98%

›Tension-free anastomosis principle

›Spatulated end to achieve wide anastomosis

›Double-J stent placed across anastomosis

›Psoas hitch

›When gap prevents tension-free reimplantation

›Bladder mobilized and hitched to psoas tendon

›Allows distal ureter bridging of up to 5 to 6 cm gap

›Combined with ureteroneocystostomy

›High success rates reported

›Boari flap

›Bladder flap tubularized to bridge larger defects

›Used when psoas hitch insufficient

›Mid-ureteral defects down to iliac vessels

›Requires adequate bladder capacity

Surgical repair - proximal and mid-ureteral injuries

›Ureteroureterostomy (primary anastomosis)

›Preferred for injuries proximal to iliac vessels

›Spatulated end-to-end anastomosis

›Over double-J stent

›Requires healthy well-vascularized ureteral ends

›Debridement of devitalized tissue

›Tension-free closure principle

›Ureteropyelostomy

›For ureteropelvic junction avulsion

›Anastomosis to renal pelvis

›Stent placement across repair

›Ileal interposition

›For extensive ureteral loss (> 6 to 8 cm)

›Segment of ileum used to replace ureter

›Complex reconstruction, delayed setting preferred

Damage control approach

›Unstable polytrauma patient strategy

›Temporizing options

›Ligate ureter + percutaneous nephrostomy for diversion

›Exteriorize ureter (cutaneous ureterostomy)

›Intubated ureterostomy with drainage

›Definitive repair deferred until resuscitated and stable

›Typically 48 to 72 hours after initial damage control

›Second-look laparotomy planning

›Stent placement after all surgical repairs

›Reduces anastomotic leak risk

›Facilitates healing

›Removed at 3 to 6 weeks under cystoscopy

Spontaneous ureteral rupture treatment

›Ureteroscopic management

›Primary approach in 72% of spontaneous rupture cases

›Double-J stent placement

›Address underlying stone if present

›Stone extraction at same setting if feasible

›Laser lithotripsy for obstructing calculus

›Basket retrieval for small fragments

›Conservative non-operative management

›Appropriate in 28% of spontaneous rupture cases

›Antibiotics, analgesia, hydration

›Outcomes comparable to stenting in select patients

›Close monitoring required

›Repeat imaging at 48 to 72 hours

›Failure triggers ureteroscopic intervention

09Special Populations/sp83

Pregnancy

›Pregnancy-specific considerations

›Spontaneous ureteral rupture risk elevated

›Ureteral dilation of pregnancy (physiologic hydroureter)

›Ureteral calculi complication in pregnancy

›Presentation overlap with obstetric emergencies

›Placental abruption, preterm labor mimics

›Urgent obstetric and urologic co-management

›Imaging approach in pregnancy

›MRI preferred over CT when clinically feasible

›No ionizing radiation

›MRI urography for collecting system assessment

›CT with fetal radiation counseling if MRI unavailable

›Fetal dose from CT approximately 4 to 35 mGy depending on gestational age

›Benefit of diagnosis generally outweighs radiation risk

›Ultrasound as adjunct for hydronephrosis

›Physiologic bilateral hydroureter complicates interpretation

›Asymmetric hydronephrosis suggests pathologic cause

›Treatment modifications in pregnancy

›Retrograde ureteral stenting preferred if possible

›Fluoroscopy minimized (lead shielding)

›Ureteroscopy with stone extraction feasible in 2nd trimester

›Antibiotics: beta-lactams preferred

›Avoid fluoroquinolones (teratogenicity)

›Avoid aminoglycosides (ototoxicity)

›Analgesia: acetaminophen preferred

›NSAIDs avoided in third trimester (premature ductus closure)

›Opioids with caution and neonatal monitoring

›Fetal monitoring when viable gestation

›Continuous CTG during surgical procedures

›Neonatology awareness

Geriatric

›Geriatric-specific risk profile

›Higher iatrogenic injury risk

›More frequent pelvic surgeries for malignancy

›Prior radiation increases surgical difficulty

›Spontaneous rupture with obstructive uropathy

›Ureteral tumors more common in older adults

›Extrinsic compression from pelvic malignancy

›Physiologic considerations

›Reduced baseline renal reserve

›Creatinine may underestimate GFR (reduced muscle mass)

›Use CKD-EPI formula for GFR estimation

›Contrast nephropathy risk elevated

›Pre-hydration important

›Minimize contrast volume

›Frailty and surgical risk assessment

›Higher perioperative complication rates

›Conservative or minimally invasive approaches preferred

›Medication adjustments

›Antibiotic renal dose adjustment

›GFR-based beta-lactam dosing

›Aminoglycosides avoided if possible

›Analgesic caution

›NSAIDs avoided (renal and GI risk)

›Opioid cautious dosing (fall risk, constipation, delirium)

›Prolonged hospital stay higher likelihood

›DVT prophylaxis from admission

›Delirium prevention bundle

Pediatrics

›Pediatric ureteral injury patterns

›Blunt trauma more common than penetrating

›Ureteropelvic junction avulsion in high-energy deceleration

›Children more vulnerable due to proportionally larger kidneys

›Less iatrogenic injury (smaller surgical volume)

›Ureteroscopy in children: higher risk due to small caliber ureter

›Imaging approach in children

›CT with contrast and excretory phase if indicated

›Pediatric dose reduction protocols mandatory

›ALARA principle: minimum mA settings

›Ultrasound as initial screen for hydronephrosis

›Avoids radiation exposure

›Formal CT if suspicion persists

›MRI alternative when CT not urgent

›MRI urography superior soft tissue detail

›Sedation or anesthesia may be required

›Treatment in children

›Retrograde stenting preferred if anatomy allows

›Smaller instruments required (4 to 5 Fr stent)

›Pediatric urologist consultation mandatory

›Antibiotic dosing weight-based

›Ampicillin-sulbactam 150 to 200 mg/kg/day IV divided every 6 hours (ampicillin component)

›Piperacillin-tazobactam 300 mg/kg/day IV divided every 6 to 8 hours

›Analgesia weight-based

›Morphine 0.1 mg/kg IV every 4 hours PRN

›Ketorolac 0.5 mg/kg IV every 6 hours (max 15 to 30 mg per dose) if renal function intact

10Background/b86

Epidemiology

›Incidence and prevalence

›Ureteral injury accounts for < 1% of all urologic injuries

›Rare but high consequence if missed

›Requires high index of suspicion

›Iatrogenic cause is most common overall

›Gynecologic surgery most frequent setting

›Colorectal surgery significant contributor

›Traumatic ureteral injury rare in blunt trauma

›< 1% of blunt abdominal trauma

›Penetrating mechanisms predominate in external trauma

›Mechanism distribution

›Iatrogenic: majority of all ureteral injuries

›Gynecologic procedures (hysterectomy) most common

›Ureteroscopy-related injuries rising with procedure volumes

›Penetrating trauma: GSW most common external mechanism

›Stab wounds less common

›Blunt trauma: rare

›Ureteropelvic junction avulsion in high-energy deceleration

›Spontaneous rupture: uncommon

›Ureteral calculi in 56% of cases

›Ureteral stricture in 17%

›Morbidity and mortality

›Delayed diagnosis major driver of morbidity

›Urinoma, abscess, urosepsis, stricture

›Potential loss of ipsilateral renal unit

›Early recognition and repair significantly improves outcomes

›Immediate repair success rate 78%

›Delayed repair success rate 61%

Pathophysiology

›Mechanisms of ureteral injury

›Penetrating trauma

›Direct laceration or transection by projectile or blade

›Concussive blast injury from high-velocity GSW

›Blunt high-energy deceleration

›Sudden stretch forces at ureteropelvic junction

›Avulsion due to fixed point at renal pelvis vs mobile ureter

›Iatrogenic mechanisms

›Direct laceration during dissection

›Thermal injury from electrocautery

›Ligation or suturing of ureter

›Devascularization from periureteral dissection

›Spontaneous rupture mechanism

›Elevated intraluminal pressure from obstructing calculus or stricture

›Forniceal rupture at weakest point (calyceal fornix)

›Extravasation into retroperitoneal space

›Consequences of untreated injury

›Urinoma formation

›Retroperitoneal fluid collection from urinary extravasation

›Secondary infection leads to abscess

›Urosepsis

›Infected urinoma or abscess

›Systemic inflammatory response with organ dysfunction

›Ureteral stricture

›Fibrosis at site of injury or repair

›Progressive hydronephrosis and renal loss

›Associated injury consequences

›Bowel injury in 46% of penetrating cases

›Vascular injury in 14% of penetrating cases

Therapeutic Considerations

›Principles guiding management

›Injury grade and location drive repair strategy

›AAST Grade I to II: minimally invasive preferred

›Grade III to V: surgical repair required

›Location determines surgical approach

›Proximal (above iliac vessels): ureteroureterostomy

›Distal (below iliac vessels): ureteroneocystostomy preferred

›Timing matters for success

›Immediate repair within 1 week: 78% success

›Delayed repair: 61% success (ACS Guidelines 2021)

›Damage control vs definitive repair

›Damage control when hemodynamically unstable

›Temporize with ligation and nephrostomy

›Definitive repair after resuscitation

›Staged repair reduces risk in critically ill patients

›Second-look laparotomy at 48 to 72 hours

›Role of ureteral stenting

›Double-J stent is cornerstone of minimally invasive management

›Provides internal drainage and scaffolding for healing

›Duration 21 days (spontaneous) to 6 weeks (surgical repair)

›Placed after all surgical repairs to protect anastomosis

›Percutaneous nephrostomy as alternative or adjunct

›Antibiotic principles

›Prophylactic coverage for all surgical repairs

›Cefazolin 2 g IV within 60 minutes of incision

›Weight-based dosing for > 80 kg

›Therapeutic antibiotics for infected urinoma or abscess

›Broad spectrum until cultures available

›Source control (drainage) equally important

11Patient Discharge Instructions/pdi33

copy discharge instructions

›Ureteral injury home care

›Ureteral stent in place (if applicable)

›Stent may cause bladder discomfort and urinary frequency

›Blood in urine is common with stent in place

›Hydration

›Drink at least 2 litres of fluid daily

›Helps flush the urinary tract

›Activity restrictions

›Avoid heavy lifting or strenuous activity until cleared by urologist

›No driving if on opioid pain medications

›Medications as prescribed

›Complete antibiotics course if prescribed

›Pain medications as directed

›Warning signs to return to emergency department immediately

›Fever above 38.5 C or chills

›Severe or worsening flank or abdominal pain

›No urine output for more than 6 to 8 hours

›Heavy bright red blood in urine (not just pink)

›Nausea and vomiting preventing oral fluid intake

›Wound drainage or swelling at any surgical site

›Confusion or difficulty thinking clearly

›Stent-specific instructions (if stent placed)

›Stent removal appointment

›Scheduled with urology (typically 3 to 6 weeks)

›Do not miss this appointment

›Stent string if externalized

›Do not pull or tug on string

12References/r29

Guidelines and key sources

›Primary clinical guidelines

›ACS Best Practices Guidelines: Management of Genitourinary Injuries, 2025

›Johnsen N, Wessells H et al

›AAST grading and management algorithms

›WSES-AAST Guidelines: Kidney and Uro-Trauma, World Journal of Emergency Surgery 2019

›Coccolini F, Moore EE, Kluger Y et al

›CT imaging protocols and operative indications

›WSES Guidelines for Iatrogenic Urinary Tract Injuries During Emergency Digestive Surgery, 2023

›de'Angelis N, Schena CA, Marchegiani F et al

›Drain fluid creatinine and detection strategies

›Key literature

›Chen GH et al. Spontaneous Ureteral Rupture and Review of the Literature. American Journal of Emergency Medicine, 2014

›72% stenting vs 28% conservative management rates

›Calculi as most common spontaneous cause (56%)

›Orcutt D et al. Ureteral Injuries Secondary to Blunt Abdominal Trauma: 15-Year Review. Urology 2022

›Level 1 trauma center outcomes data

›89% success rates for partial and complete repairs

›Abboudi H et al. Ureteric Injury: A Challenging Condition to Diagnose and Manage. Nature Reviews Urology 2013

›Immediate vs delayed repair outcome comparison

›78% immediate vs 61% delayed success rates

›ACR Appropriateness Criteria: Minor Blunt Trauma. JACR 2026

›CT excretory phase sensitivity 93%, specificity 100%

›ICD-10 coding

›S37.10: unspecified injury to ureter

›S37.11: minor contusion of ureter

›S37.12: major contusion of ureter

›S37.19: other injury of ureter

Learn More: Ureteral Rupture→

Comprehensive Clinical Review

Structured, evidence-informed, long-form analysis for deeper understanding.

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed August 18, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.