title: Gunshot wounds to the lower urinary tract: a single-institution experience.
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.
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  Epidemiologic study, level IV.
authors: Department of Urology, San Francisco General Hospital, University of California-San Francisco, San Francisco, California 94117, USA.
authors: Nadya M
authors: NM
authors: Cinman
authors: Jack W
authors: JW
authors: McAninch
authors: Sima P
authors: SP
authors: Porten
authors: Jeremy B
authors: JB
authors: Myers
authors: Sarah D
authors: SD
authors: Blaschko
authors: Herman S
authors: HS
authors: Bagga
authors: Benjamin N
authors: BN
authors: Breyer
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis / Q000601:surgery*; D011446:Prospective Studies; D014193:Trauma Centers; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014551:Urinary Tract / Q000293:injuries* / Q000601:surgery; D013520:Urologic Surgical Procedures / Q000379:methods*; D014948:Wounds, Gunshot / Q000175:diagnosis / Q000601:surgery*; D055815:Young Adult