Gunshot wound injuries of the prostate and posterior urethra: reconstructive armamentarium.
OBJECTIVE
Descriptions of posterior urethral penetrating injuries are rare in the literature and their management is poorly described. We reviewed the medical records of 19 men who sustained posterior urethral gunshot wounds and report our experience with various treatment options.


METHODS
We retrospectively reviewed the records of 19 men (mean age 27 years) who sustained posterior urethral gunshot wound injuries confirmed by retrograde urethrography and/or exploratory laparotomy. Treatment options included immediate primary repair in 2 patients, delayed reconstruction in 15 and complete prostatectomy in 2. Outcomes were described by flow rates and lower urinary tract symptoms.


RESULTS
Of 15 patients who underwent delayed repair 13 (86.6%) demonstrated normal flow rates and lack of lower urinary tract symptoms. The 2 remaining patients experienced obliterative stricture recurrences and were treated with open surgery. Both patients who underwent immediate primary repair had normal flow rates. Of the 2 men who underwent immediate prostatectomy 1 had moderate incontinence requiring absorbent pad use and the other was lost to followup after he was discharged home with a suprapubic catheter in place.


CONCLUSIONS
An initial management strategy based on the principles of maximizing urinary catheter drainage, with direct retropubic repair/urethral realignment when possible and definitive perineal reconstruction when necessary, appears to provide acceptable outcomes while minimizing the number of subsequent interventions required.
Tausch
Timothy J
TJ
Urology Service, Brooke Army Medical Center, Fort Sam Houston, Texas 78234, USA.
Cavalcanti
Andre G
AG
Soderdahl
Douglas W
DW
Favorito
Luciano
L
Rabelo
Paulo
P
Morey
Allen F
AF
D000293:Adolescent; D000328:Adult; D000368:Aged; D001753:Blast Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D009104:Multiple Trauma / Q000000981:diagnostic imaging / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D011467:Prostate / Q000293:injuries*; D011468:Prostatectomy; D012086:Reoperation; D014521:Urethra / Q000293:injuries* / Q000601:surgery; D014524:Urethral Obstruction / Q000000981:diagnostic imaging / Q000601:surgery; D014547:Urinary Diversion; D014563:Urodynamics / Q000502:physiology; D014567:Urography; D014948:Wounds, Gunshot / Q000000981:diagnostic imaging / Q000601:surgery*