Firearm-Related External Genital Trauma: Contemporary Management Strategies and Outcomes to Inform Urologic Trauma Guidelines.

OBJECTIVE: To describe our experience with contemporary management and short-term outcomes of firearm-related genital trauma presenting to a Level 1 safety-net trauma hospital. METHODS: We conducted a retrospective chart review of patients who presented to a Level 1 safety-net trauma hospital in an urban setting with firearm-related penile/urethral and scrotal trauma between 2019 and 2024. Data collected included demographics, injury complex, follow-up rates, and short-term complications. Pre-specified multivariable logistic regressions were performed to identify predictors of follow-up rates and complications. RESULTS: Of 198 patients with firearm-related genital trauma, 85 (42.9%) had penile/urethral injuries and 113 (57.1%) had scrotal injuries. Ninety-seven (48.9%) patients had concomitant injuries to other GU organs, while 99 (50%) had concomitant injuries to non-GU organs (Table 1). Multivariable regression demonstrated that concomitant injury to other GU organs (p=0.004), non-GU organ systems (p=0.050), and surgical repair (p < 0.001) were associated with adherence to follow-up (Table 2). Penile/urethral involvement (p=0.008) and surgical repair (p=0.024) were associated with having a 30-day complication (Table 3). Of 38 (34.2%) patients who completed scrotal ultrasound, 24 did not have sonographic evidence of testicular injury. Of these, 21 were managed conservatively with no short-term complications (Table 4a). CONCLUSIONS: Penile/urethral involvement, surgical repair, and multi-organ injury were associated with higher complication and follow-up rates. The variations we observed in management pathways demonstrate that in certain clinical scenarios, invasive management may be deferred while maintaining acceptable outcomes and minimizing complications.