Management and Outcomes of Anterior Urethral Injuries From Gunshot Wounds: A 7-year Single-center Experience

To describe injury patterns, management, and outcomes of anterior urethral injuries secondary to gunshot wounds over 7 years at a Level I trauma center.

We retrospectively identified men with anterior urethral injuries secondary to gunshot wounds who underwent retrograde urethrogram between May 2018 and October 2025. Management and outcomes were analyzed.

Nineteen men sustained penetrating anterior urethral injuries due to gunshot wounds. Injury locations included bulbar (11), penile (7), and both (1). Bulbar injuries were most often managed with catheterization or suprapubic drainage (75%, 9/12); 78% (7/9) healed without further intervention, while 2 required repairs (1 planned for extensive injury and 1 for persistent leak). The 3 patients who underwent urgent bulbar reconstruction all had concomitant genitourinary injuries requiring operative management. Among penile injuries, 63% (5/8) underwent primary repair with no subsequent strictures or leaks. Of the remaining patients, 2 developed persistent leaks requiring prolonged catheterization, and 1 required planned two-stage repair. Concomitant corporal body injury occurred in 88% (7/8) of penile injuries, and scrotal trauma occurred in 42% (8/19) of all cases. Overall, delayed urethroplasty was performed in 16% (3/19). One patient reported new mild-to-moderate erectile dysfunction, and all ultimately voided spontaneously.

This represents the largest contemporary series of anterior urethral trauma secondary to gunshot wounds. Our findings support early primary repair for penile urethral injuries, while catheter drainage with selective delayed reconstruction may be appropriate for bulbar injuries in appropriately selected patients. Associated corporal body and scrotal injuries warrant consideration during initial evaluation.