Penetrating Trauma to the Genitourinary System: Incidence and Outcomes of a New, High-Volume Trauma Center

INTRODUCTION: There is a paucity of literature regarding the incidence and outcomes of penetrating genitourinary (GU) injuries due to the rarity of these wounds. Our objective is to describe the incidence of GU injuries at a center with a uniquely high 41% penetrating trauma rate. METHODS: A retrospective chart review was performed identifying patients from May 2018 to October 2020 with GU injuries including kidney, ureter, bladder, urethra, penis, and scrotum/testis. Trauma and demographic characteristics were assessed. Stata 16.1 was used for statistical analysis. RESULTS: We identified 212 penetrating urologic injuries in 176 patients (2.2% of trauma activations): 78 (37%) kidney, 48 (23%) scrotal, 34 (16%) penis, 26 (12%) bladder, 18 (8%) ureter, and 8 (4%) urethral injuries. The median age was 26 years (IQR 21 to 41). Patients with external genitalia injuries (penis, scrotum and/or urethra) had significantly lower Injury Severity Scores compared with those with injuries to other urologic organs (p < 0.001; Table). On multivariate analysis, mortality was associated with increasing age (OR 1.08; p = 0.027) and blood transfusions (OR 1.16; p = 0.046) but not to a urologic injury. Each extra unit of blood was associated with a 9% increase in odds of overall complications and with an increase in hospital LOS by 0.55 days. Median follow-up was 1.6 months (IQR 0.5 to 9.7). CONCLUSION: We present one of the largest contemporary civilian series describing the prevalence and outcomes of GU injuries in penetrating trauma. Mortality is associated with nongenitourinary factors. Poor follow-up prevents full evaluation of long-term urologic outcomes. Table. - Mean Injury Severity Score for Patients with Genitourinary Organ Injuries Genitourinary organ injured N Mean Injury Severity Score (SD) Bladder 17 18.71 (8.97) Kidney 69 22.99 (9.99) External genitalia 61 8.43 (8.81) Ureter 15 16.07 (8.73) Multi-urologic organs 14 20.93 (10.98) All patients 176 16.77 (11.33)