The management of urinary tract injuries after gunshot wounds of the anterior and posterior abdomen

Abstract

Gunshot wounds of the urinary tract are seen with increasing frequency due to the widespread use of firearms. There is much controversy regarding the optimal preoperative diagnostic evaluation and intraoperative management of such injuries. Debate also arises as to the need for mandatory exploration or the safety of non-operative management for carefully selected patients. Seventy-nine prospective patients with injuries of the urinary tract after a truncal GSW were analyzed. The incidence of renal repair, nephrectomy, bladder repair and ureteral repair was 14, 21, 27 and 9 per cent, respectively. Five (6 per cent) patients were managed non-operatively and 16 (20 per cent) more underwent abdominal but not renal exploration. From 21 (26.5 per cent) cases with complications, only three (4 per cent) patients developed complications which were associated with the urinary tract injuries. Although the majority of patients with GSWs of the urinary tract will require abdominal exploration, invasion of Gerota's fascia may be spared in cases of stable renal haematomas. A high index of suspicion followed by adequate exploration is required to avoid missed ureteral injuries. Bladder perforations almost always require surgical repair.