THE MANAGEMENT OF URINARY-TRACT INJURIES AFTER GUNSHOT WOUNDS OF THE ANTERIOR AND POSTERIOR ABDOMEN

Gunshot wounds of the urinary turret are seen with increasing frequenc y due to the widespread use of firearms. There is much controversy reg arding the optimal preoperative diagnostic evaluation and intraoperati ve management of such injuries. Debate also ar ises as to the need for mandatory exploration or the safety of non-operative management for c arefully selected patients. Seventy-nine prospective patients with inj uries of the urinary tract after a truncal GSW were analyzed. The inci dence of venal repair, nephrectomy, bladder repair and ureteral repair was 14, 21, 27 and 9 per cent, respectively. Five (6 per cent) patien ts were managed non-operatively and 16 (20 per cent) move underwent ab dominal bur not venal exploration. From 21 (26.5 per cent) cases with complications, only three (4 per cent) patients developed complication s which were associated with the urinary tract injuries. Although the majority of patients with GSWs of the urinary tract will require abdom inal exploration, invasion of Gerota's fascia may be spared in cases o f stable renal haematomas. A high index of suspicion followed by adequ ate exploration is required to avoid missed ureteral injuries. Bladder perforations almost always require surgical repair. (C) 1997 Elsevier Science Ltd. All rights reserved.