Gun violence (GV) is an ongoing public health problem in the United States.¹ At the same time, there is ongoing political debate around the funding of GV research and the physician’s role in prevention.² We reviewed a series of GV injuries with and without genitourinary (GU) involvement in order to better understand the impact of these injuries on victims, our community hospital and payers.

Trinity Health Muskegon (THM) is a 409-bed hospital, with a level II trauma center, located in Muskegon, Michigan. We collaborated with emergency medicine colleagues to determine appropriate International Classification of Diseases-9 and -10 diagnostic codes which were used to search the THM trauma center database between May 1, 2015 and June 30, 2019 for GV injuries. Patient demographics, Injury Severity Score, length of stay and mortality rates were abstracted. Hospital charges and payer data were obtained from the THM finance department. In many cases, physician care was provided by independent providers. As a result, physician charges were not calculated. Chi-square or Fisher’s exact test was utilized for comparisons of categorical data, and t-test or Mann-Whitney test was utilized for quantitative data. Significance was assessed at p <0.05.

A total of 213 patients met the inclusion criteria, of whom 14 (6.6%) sustained injuries to the GU tract. Organ injuries occurred to the penis (1), scrotum (2), penis and scrotum (2), spermatic cord (1), testis (1), bladder (1), ureter (1), left renal hilum (1), right kidney (2), left kidney (2) and both kidneys (1). Of these, 12/14 (86%) also sustained concomitant non-GU organ injuries. Management of GU injuries included observation (6), repair of scrotal laceration (2), orchiectomy (3), laparoscopic repair of bladder (1), ureteral stent placement (2), open repair of ureter (1), open repair of renal laceration (1) and nephrectomy (1).

Urologists in our community treat a wide range of GV injuries that disproportionally affect young Black men (see Table). Victims who sustained GV injuries to the GU tract were more likely to have suffered 1 or more previous GV injuries, though this did not reach statistical significance. Injuries with GU involvement were significantly more severe and resulted in longer hospitalizations and higher hospital charges. Hospital-based care for victims was predominantly paid for by Medicaid. GV injuries with GU involvement resulted in a net loss of revenue for our hospital of approximately $880,294.

In an effort to stem the tide of GV, the ACS COT (American College of Surgeons Committee on Trauma) recently made GV research and prevention a priority.³ In addition, innovative community- and hospital-based violence and GV prevention efforts are currently being implemented and studied around the county.⁴ The ongoing GV in our cities has made many of us feel helpless.⁵ As urologists, given the impact these injuries have on the patients and communities we serve, we are in a unique position to support research efforts such as those of ACS COT, and become aware of existing community-and hospital-based GV prevention efforts.