Editing Functional: Urinary Fistulae (section)

==== Causes ====
* '''<span style="color:#ff0000">Surgical injury to the distal 1/3 ureter (below the level of the iliac vessels)</span>'''
** '''<span style="color:#ff0000">Most common cause: hysterectomy</span>''' for benign indications
*** Most common injury to the urinary tract during hysterectomy is a bladder laceration. 
****Although ureteral injuries are not uncommon, they occur far less frequently than bladder injuries.
** The pelvic ureter is intimately related to the female genital tract throughout its course.
*** In the deep pelvis, the ureter passes at the lateral edge of the uterosacral ligament and ventral to the uterine artery, and then passes just lateral to the cervix and fornix of the vagina.
** In females who undergo vaginal surgery (such as hysterectomy) or sustain penetrating pelvic trauma involving the vagina, an initially unrecognized ureteral injury can present in a delayed manner with ureterovaginal fistula.
* '''Other risk factors include: gynecologic surgery (cesarean section, anterior colporrhaphy (cystocele repair)), vascular surgery, urologic surgery including retropubic bladder neck suspensions, colon surgery, locally advanced malignancy, radiation therapy, pelvic trauma, chronic inflammatory diseases (e.g., actinomycosis), endometriosis and obesity'''
** Incidence of iatrogenic ureteral injury during major gynecologic surgery ≈0.5-2.5%