This protocol applies when a ureteral injury is identified at the time of the operation — before wound closure — and the patient remains haemodynamically stable throughout. Intraoperative recognition while the patient is stable is the key trigger for this management pathway.
Iatrogenic ureteral injuries recognised during surgery should be repaired immediately. The patient's haemodynamic stability is central: in unstable patients a damage-control strategy — ureteral ligation, urinary diversion, and delayed definitive repair — takes precedence instead of immediate reconstruction.
Immediate surgical reconstruction is the recommended response, carried out via open, laparoscopic, or robot-assisted technique. The operative approach is determined by the location of the injury along the ureter and the length of the affected segment — several distinct reconstructive options are available for upper-third, middle-third, distal, and long-segment injuries. The complete decision algorithm, including all specific techniques and their selection criteria, is in the full protocol.