Ureteral injuries during abdominal and pelvic surgery occur with an incidence of <1%, most commonly during hysterectomy or colectomy. The proximity to non-urological organs and the anatomical course of the ureter makes the distal ureter most prone to injury; subsequently, approximately 80% of injuries occur at the level of the distal ureter. Prevention or immediate recognition of injuries is essential for proper repair to mitigate both short- and long-term sequelae. Preoperative ureteric stents have been widely employed for the early recognition and prevention of injury; however, data supporting their use is controversial owing to retrospective and small, underpowered, prospective studies. Several options are available for repair when a distal ureteral injury is recognized, ranging from ureteral stent placement and/or percutaneous drainage to distal ureteral reimplantation, and other reconstructive options including the psoas hitch and Boari flap. Here, we describe the prevention, recognition, and management of distal ureteral injuries.