Deployment related genitourinary (GU) trauma is a uniquely devastating injury that
has become increasingly common during the recent wars in Iraq and
Because battlefield medical care has improved throughout the Iraq and
Afghanistan wars, many more U.S. servicemen have survived what could
have been fatal injuries in the past. This has resulted in many more
veterans returning with GU injuries.
‘There is need for novel treatments to improve sexual, urinary, or reproductive function among United States service members with severe genital injury.’
In an article in The Journal of Urology
researchers from the U.S. military medical community have examined the
extent and severity of GU injuries among nearly 1,400 U.S. service
members (SMs) and emphasize the critical need for novel treatments to
improve sexual, urinary, or reproductive function among those with
severe genital injury.
Lead investigator Lieutenant Colonel Steven J.
Hudak, Urology Clinic, Department of Surgery, Brooke Army Medical
Center, Fort Sam Houston, Texas, said, "GU injury related urinary, sexual, and
reproductive dysfunction is likely to be highly disruptive during the
challenging course of recovery after complex poly trauma, especially for
young SMs. Continued investment and research in GU injury prevention,
organ reconstruction and replacement, gamete preservation, and physical
as well as psychological rehabilitation are greatly needed."
The Department of Defense Trauma Registry (DoDTR) collects data from
the medical records of trauma patients deployed to support combat
operations who are treated at U.S. military hospitals. Researchers
reviewed the records of more than 29,000 SMs wounded during Operation
Iraqi Freedom (OIF, October 16, 2002 to December 15, 2011) and Operation
Enduring Freedom (OEF, October 7, 2001 to December 28, 2014). Of these,
1,367 men survived after sustaining one or more GU injuries. These SMs
became the subjects of the TOUGH (Trauma Outcomes and Urogenital Health)
project, a U.S. Department of Defense funded study to describe the
epidemiology and long-term outcomes of GU injury among SMs wounded in
OIF and OEF.
The study provided three key findings.
1) The external genitalia was the predominant GU region injured during OIF/OEF
2) Severe testicular and/or penile injury occurred in a substantial proportion of the patients studied
3) GU injuries were often part of a larger constellation of poly
traumatic injuries, which frequently included lower extremity
amputation(s), colorectal injury, and/or traumatic brain injury (TBI)
GU injuries have the unique potential to adversely alter the sexual
and reproductive health of the injured SMs. "The impact of sexual and
reproductive problems may be amplified for younger individuals who are
still in the process of sexual identity development, who are unmarried,
and/or who wish to father children," noted Dr. Hudak. For some men,
paternity is no longer possible without the use of donor sperm, which is
not a covered medical benefit for current or former U.S. SMs.
More than a third of patients studied sustained at least one severe
GU injury (36.7%). Most (81.4%) were younger than 30 years old, junior
enlisted SMs (59.6%) and members of the U.S. Army or U.S. Marine Corps
(95.6%). Battle injuries predominated (88.6%) and the primary mechanism
of injury was explosive (74.1%) resulting in penetrating injuries
The majority of patients had at least one injury to the external
genitalia (73.2%). The specific external GU organs injured were scrotum
(55.6%), testes (33.0%), penis (31%), and/or urethra (9.1%). While only
12% of scrotal and 20% of penile injuries were severe, over 63% of
testicular injuries were severe.
Common comorbid injuries included TBI (40.2%), pelvic fracture
(25.0%), and colorectal injury (21.7%). When an SM had a severe GU
injury, 31.1% also had colorectal trauma, as opposed to 16.3% of those
with less severe GU injury. Lower extremity amputation occurred in more
than a quarter of SMs with GU injury (28.7%).