**11. Conclusions**

Sound knowledge of ureteral anatomy is critical to the avoidance of injury. In the event that the ureter is damaged during gynecologic surgery, intraoperative diagnosis allows for immediate repair in most cases. For this reason, intraoperative confirmation of ureteral integrity should be routine, whether the surgical approach is transvaginal or transabdominal through the open, laparoscopic, or robot-assisted approach. The ureter may be assessed visually, by palpation, or cystoscopically. Identification of the mechanism of injury and its location guides immediate or delayed repair. With proper recognition and therapy, ureteral function can be restored, and renal function maintained.
