Treatment of Ureteral Injury with Delayed Diagnosis Not Identified Intraoperatively

This protocol addresses ureteral injuries in which the diagnosis is delayed — cases not identified at the time of surgery. Delayed recognition occurs in the majority of ureteral injuries resulting from both blunt trauma and iatrogenic causes, creating a distinct management challenge compared to injuries caught intraoperatively.

When a ureteral injury goes undetected during the initial procedure, patients typically present later with signs of urinary extravasation, obstruction, or fistula formation. Endo-urological approaches — including internal stenting, with or without dilatation — represent the first-line step in most delayed-diagnosis cases before consideration of open intervention.

Management of delayed-diagnosed ureteral injury may involve urinary diversion strategies or, in select cases involving loss of renal function or parenchyma, more definitive intervention. The full structured approach — including the sequencing of options and criteria guiding each decision — is outlined in the complete protocol.