Objectives: We examined our experience with ureteral injuries to review recent trends in etiologies, treatment, and outcomes. Methods: We conducted a retrospective study of iatrogenic and traumatic ureteral injuries over the last 5 years. We reviewed radiographic, hospital, and outpatient office records for demographic data, etiology, associated factors, management, and outcomes. Results: We identified 45 patients with 47 ureteral units. Gynecologic surgeries caused 44% of the ureteral injuries. Traumatic ureteral injuries accounted for 24.5%. Ureteroscopy was associated with 17.8% of the injuries. Vascular, colorectal, and spine surgery were the causes of injuries in 15.5% of patients. Of the ureteral injuries, 65% were distal, 22% were mid, 9% were proximal, and 2 patients had multifocal injuries. Overall, 36% were right- and 64% were left-sided. Cases were successfully managed 11% of the time with ureteral stenting (with or without nephrostomy drainage) without need for open surgical repair. Definitive open surgical treatment was needed in 89% of the cases. The most commonly used operation for definitive repair of ureteral injuries was the psoas hitch ureteral reimplant. This was used in 22 of 45 cases (49%). Patients were cured in 95% of the cases. Conclusions: Gynecologic surgery remains the most common cause of ureteral injuries. Trauma is the next most common cause; however, ureteroscopy is the second most common cause of iatrogenic injuries. Stenting alone was rarely successful and most required definitive open surgery. Copyright © 2005 by lippincott Williams & Wilkins.