Genitourinary injuries and extremity amputation in Operations Enduring Freedom and Iraqi Freedom

Nnamani, Nina; Janak, Jud C.; Hudak, Steven J.; Rivera, Jessica C.; Lewis, Eluned; Soderdahl, Douglas W.; Orman, Jean A.

doi:10.1097/ta.0000000000001122

Cited by 23 publications

(9 citation statements)

References 25 publications

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“…15 Regarding GU complications, Nnamani et al reported that low testosterone was common in participants with GU injuries, sometimes resulting in sexual dysfunction and difficulty in completing ADLs. 24 Another study by Metze et al found that in polytraumatized participants, other conditions like spinal cord lesions, traumatic brain injury, hand injuries, anxiety, depression, and pelvic pain all contributed to sexual dysfunction. 25 The nature of limb loss at the hip and pelvic level has major implications on the GI and GU systems, especially in the setting of IED blasts because of a lack of sufficient body armor in this area.…”

Section: Gi and Gu Functionmentioning

confidence: 99%

“…25 The nature of limb loss at the hip and pelvic level has major implications on the GI and GU systems, especially in the setting of IED blasts because of a lack of sufficient body armor in this area. 24,26 The most frequent locations of operation after IED blasts are the testis (20.6%), bladder (18.9%), scrotum (17.8%), and the kidneys (13.5%). 24…”

Section: Gi and Gu Functionmentioning

confidence: 99%

“…24,26 The most frequent locations of operation after IED blasts are the testis (20.6%), bladder (18.9%), scrotum (17.8%), and the kidneys (13.5%). 24…”

Section: Gi and Gu Functionmentioning

confidence: 99%

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The lived experience of military beneficiaries with amputations at the hip and pelvic level

Spinuzza,

McHugh,

Garland

et al. 2024

Prosthetics &Amp; Orthotics International

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Background: Hip- and pelvic-level amputations are devastating injuries that drastically alter patient function and quality of life. This study examined the experience of military beneficiaries with a hip- or pelvic-level amputation to better characterize their challenges and specific needs and to optimize treatment in the future. Methods: We conducted a retrospective review of the Military Health System and identified 118 patients with a history of one or more amputation(s) at the hip or pelvic level between October 2001 and September 2017. Surviving participants (n = 97) were mailed a letter which explained the details of the study and requested participation in a telephonic interview. A total of six individuals (one female, five males) participated in structured interviews. Results: The study group included four participants with hip disarticulations and two participants with hemipelvectomies (one internal, one external). All six participants reported significant challenges with activities related to prosthetic use, mobility, residual limb health, pain, gastrointestinal and genitourinary function, psychiatric health, and sexual function. Conclusions: These interviews highlight the unique needs of individuals with hip- and pelvic-level amputations and may improve access to higher echelons of care that would enhance the function and quality of life for these participants.

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Section: Gi and Gu Functionmentioning

confidence: 99%

Section: Gi and Gu Functionmentioning

confidence: 99%

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The lived experience of military beneficiaries with amputations at the hip and pelvic level

Spinuzza,

McHugh,

Garland

et al. 2024

Prosthetics &Amp; Orthotics International

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“…Many of these patients do not have adequate donor sites for the flaps and are missing soft tissue, and recipient vessels, and so on at the recipient sites. Because of the perineal damage caused by blast injuries, many wounded warriors lack the eligibility for a phalloplasty [10]. The emerging concept of GUVCA holds significant promise for such patients, and is exemplified by the remarkable GUVCA performed by Redett's group at Johns Hopkins on such a patient with genitourinary tissue loss and extensive abdominal, and perineal tissue loss, who received the most complex GUVCA to date.…”

Section: Current Reconstructive Optionsmentioning

confidence: 99%

Genitourinary vascularized composite allotransplantation: a review of penile transplantation

Jonczyk

Tratnig-Frankl

Cetrulo

2019

Current Opinion in Organ Transplantation

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Purpose of reviewVascularized composite allotransplantation (VCA) has developed over the past 20 years, resulting in promising new reconstructive prospects for extensive soft tissue defects. More than 200 VCAs have been performed worldwide, including five genitourinary (GU)VCAs and here we review the most recent literature in this field. Recent findingsDevelopments in GUVCA are continuously evolving to improve patient outcomes and suggest ethical equivalency to solid organ transplant. Recent treatment options have focused on preventing GUVCA complications by acknowledging the immunogenic tissue composition of the penis to treat rejection episodes and implementing stem cell transplant to recognized the GUVCA as self. Utilizing modern, postoperative, treatments can minimize complications and although the ethical dilemma remains, the morality of performing a GUVCA has diminished. The ethical focus relic's on standardization of patient safety. SummaryGUVCA has become an established reconstructive surgical option. The prospect of VCA's future insinuates systemization between multidisciplinary VCA programs and the United Network for Organ Sharing in efforts to endorse ethical standardization. Over the last five years, the unprecedented outcomes have shown purpose to GUVCA that initiates an obligation to help those with severe genitourinary tissue defects. Progress in immunobiology continues to evolve optimal immunosuppression drug regimens and tolerance induction protocols, highlighting potential new immunologic pathways for graft acceptance.

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“…Finally, genitourinary injuries may result from penetrating and blast trauma both within both the civilian and military population. Review of the Department of Defense Trauma Registry from October 2001 through August 2013 found 1,367 service members with genitourinary injuries, with 31% involving the penis (18). …”

Section: Introductionmentioning

confidence: 99%

Ushering in the era of penile transplantation

Rasper

Terlecki

2017

Transl. Androl. Urol.

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Penile transplantation is a novel approach to management of penile loss in the developing field of composite tissue allotransplantation (CTA). Prior management for significant penile loss has been free flap phalloplasty with issues related to function, cosmesis, and functional loss from the location of flap harvest. Transplantation has been an evolving field with advancement in CTA over the past several decades leading to the option of penile transplant. Management of penile injury with replantation provided some preliminary groundwork on the technical aspects for penile transplantation. Additionally, penile transplantation raises many ethical, emotional, and psychological considerations with need for patience amidst ongoing advancement within the field.

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Genitourinary injuries and extremity amputation in Operations Enduring Freedom and Iraqi Freedom

Abstract: Epidemiologic/prognostic study, level III.

Cited by 23 publications

References 25 publications

The lived experience of military beneficiaries with amputations at the hip and pelvic level

The lived experience of military beneficiaries with amputations at the hip and pelvic level

Genitourinary vascularized composite allotransplantation: a review of penile transplantation

Ushering in the era of penile transplantation

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