During a period of slightly over nine years, 4,195 extensive gynecologic procedures were performed and 40 patients required ureteral operations, with the ureteral injury unintentional in 16 patients. Extensive complications occurred in seven of 40 patients; in two of three patients in whom the injury was recognized postoperatively, nephrectomy was required. Roentgenographic imaging of the genitourinary tract prior to operation did not prevent injury nor did attempts at identification of the ureter. The majority of ureteral repairs were accomplished by ureteroneocystotomy. In selected patients, placement of percutaneous or indwelling ureteral stent prevented extensive surgical intervention.