Purpose <p>Iatrogenic ureteral injuries, while uncommon, are increasingly recognized as a significant source of morbidity and mortality following surgical or medical procedures. The aim of our study is to present a multi-step anterograde approach to treating these injuries, discuss the outcomes, and attempt to classify the injuries based on the mechanisms that caused them.</p> Materials and methods <p>In this monocentric retrospective study, we evaluated patients who were treated for an IUI using a multistep, anterograde approach involving percutaneous nephrostomy, nephro-ureteral stenting, and anterograde stenting. Injuries were categorized as leakage, occlusive or mixed. Clinical success, drainage dependency, time-to-recanalization, ureteral recanalization rate, ureteral patency and kidney function post-intervention were evaluated as outcome measures.</p> Results <p>The study included 38 patients who underwent 44 procedures, with a mean follow-up of 4.2 years. The clinical success rate was 89.5%. The ureteral recanalization rate was 72.7% and, after 6 months, 16 lesions (66.7%) were stent-free. The outcome was significantly better in lesions recanalized within 5 days (<i>p</i> &lt; 0.0001, OR 45.5). Leakage injuries had a higher chance of being recanalized (<i>p</i> = 0.0067, OR 0.1) and better kidney function (<i>p</i> = 0.009, OR 35.3) compared to non-leakage ones. A time to diagnosis &lt; 5 days was associated with preserved kidney function (<i>p</i> = 0.0031, OR = 0.025).</p> Conclusion <p>Iatrogenic injuries can be effectively managed with a percutaneous anterograde approach, yielding favorable long-term outcomes. The type of injury and the time to diagnosis are critical factors that influence clinical results.</p> Graphical abstract <p></p>