Gunshot wounds to the lower urinary tract

Abstract

BACKGROUND This study aimed to analyze characteristics and outcomes of gunshot wounds to the lower urinary tract at our Level I trauma center. Our hypothesis is that gunshot wounds to the lower urinary tract have characteristic bullet trajectories, injury patterns, and associated injuries. METHODS Our prospective trauma database was composed of reviewed gunshot wounds to the lower urinary tract including the pelvic ureter, bladder, or urethra from 1989 through 2011. RESULTS We identified 50 patients (median age, 25 years; range, 3–53 years) with lower urinary tract injury. There was a mean of 2.3 bullets per patient (range, 1–8), with 26 patients injured from a single bullet. Urologic injury involving only the bladder occurred in 72% (36 of 50) of the patients. Ureteral injury was diagnosed in 20% (10 of 50) of the patients. Bullet trajectory was known in the majority of multiple bullet injuries and all cases involving a single bullet. All patients but one were managed operatively. During exploration, 90% (34 of 38) with transmural bladder injury had recognized bladder entry and exit wounds. Overall, 80% (40 of 50) had concurrent gastrointestinal injury. In patients with a single gunshot wound to the lower urinary tract, 58% (15 of 26) sustained concomitant intestinal injury, and 23% (6 of 26) sustained rectal injury. Of 20 posteroanterior gunshot wounds, 80% had buttock entry. All 10 single-bullet buttock-entry gunshot wounds injured the bladder. Isolated ureteral injury was associated with lower abdominal entry and anteroposterior trajectory. Urethral injury occurred in 4, with 75% upper-thigh entry. CONCLUSION Penetrating injuries to the lower urinary tract most commonly involve the bladder. During exploration for gunshot wounds to the bladder, two injury sites should be expected because failure to close may lead to complications. Gunshot wounds to the lower urinary tract often occur with concomitant bowel injury, with buttock entry. A multidisciplinary approach involving general surgery is imperative.

Penetrating Trauma to the Ureter, Bladder, and Urethra

“…As opposed to blunt trauma, penetrating trauma generally requires surgical exploration 13 . A retrospective review from the San Francisco General Hospital, a level 1 trauma center, showed that 84% of GSWs were to the bladder 31 . Additionally, 80% were associated with a concomitant bowel injury, with 34% being a rectal injury.…”

“…These patients should initially be managed with a suprapubic catheter. In general, attempted urethral reconstruction should be delayed until 3–6 months after the injury when scar formation has stabilized and sufficient healing has occurred 31 .…”

Trauma of the Kidney, Ureter, and Bladder

“…Gunshot wounds are the most frequent cause of penetrating bladder trauma. Surgical exploration is indicated for gunshot wounds to the bladder; 82 % have a concomitant injury to the intestine; 90 % have two sites of transmural bladder injury necessitating a thorough examination of the bladder and bladder neck specifically looking for two sites of bladder injury [ 34 ].…”

Harnblasenverletzungen

“…Wie penetrierende Harnblasenverletzungen bedürfen intraperitoneale Harnblasenverletzungen bei Beckentraumata grundsätzlich immer der direkten operativen Versorgung [29,36] …”