E2368. Bladder and Urethral Gunshot Wounds: Characterization of Imaging
  1. Caleb Elmore; University of Louisville; University of Pikeville - Kentucky College of Osteopathic Medicine
  2. Nicholas Kemper; University of Louisville
  3. Rebecca Guan; University of Louisville
  4. Minh Tran; University of Pikeville - Kentucky College of Osteopathic Medicine
  5. Henderson Jones; University of Louisville
  6. Jonathan Joshi; University of Louisville
Genitourinary injuries represent 10% of penetrating trauma cases nationwide. Prompt diagnosis is essential, especially given a significant number of injuries can be overlooked due to masked physical symptoms and overshadowing concomitant injuries. The objective of this study was to gather data on radiologic imaging, management, and outcomes of bladder and urethral gunshot wounds (GSWs) at the University of Louisville Hospital. This IRB-approved case series was developed by review of 2438 sequential patients who presented to the University of Louisville Hospital with a GSW between June 1, 2016 - May 31, 2022. The dataset was obtained from the Trauma Registry maintained by the University of Louisville Department of Surgery.

Educational Goals / Teaching Points
In lower urinary tract (LUT) GSWs, there are a wide range of imaging modalities that can aid in diagnosis of injuries. CT imaging of abdomen and pelvis with contrast, is the gold standard in abdominopelvic injuries, but it may not adequately diagnose injuries. Suspected LUT injuries should undergo retrograde urethrogram/cystograms and/or CT injection cystograms for proper diagnosis prior to or immediately following OR intervention.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
21 patients were identified with lower urinary tract GSW injuries; 14 bladder injuries consisted of bladder wall, neck, and dome perforation. Of the 14 bladder injuries, 7 had initial CT imaging, 3 of which suggested injury. 6 of the bladder injury cases were diagnosed via CT cystogram or retrograde cystogram. The remaining cases were diagnosed in the OR via cystoscopy or exploratory laparotomy. Postoperatively, 11 bladder injury patients underwent follow-up cystourethrography, all of which showed no extravasation. 2 bladder injuries were discovered after initial OR intervention for concomitant GSW injuries via cystourethrography due to clinical suspicion. 7 urethral injuries consisted of bulbar urethral, anterior urethral, posterior urethral, and prostatic urethral injuries. Prior to initial OR intervention, 4 of 7 urethral injuries were not detected via CT imaging. 6 of the urethral injuries were diagnosed prior to surgery via retrograde urethrogram, visual inspection, or CT cystogram. Postoperatively 5 of these patients underwent follow-up cystourethrography, all of which showed no extravasation. One patient’s urethral injury was diagnosed after OR intervention via cystourethrography due to gross hematuria.

Although CT is the gold standard for identification of abdominopelvic injuries, patients with suspected lower urinary tract penetration injury benefit from the use of presurgical retrograde urethrogram or CT cystogram or perisurgical cystoscopy to identify bladder and urethral injuries. Postoperative patient care often benefits from follow-up urinary tract imaging prior to discharge to look for urinary extravasation, especially in the presence of new or continued urinary symptoms.