Military genitourinary injuries: past, present, and future

Abstract

Genitourinary (GU) injuries among military service members are as old as war itself. The frequency and clinical picture of GU injuries sustained in conflicts over the ages have evolved along with the constantly changing nature of combat. In this review, we discuss changing trends in the diagnosis and management of GU injuries over the past century and introduce areas of innovation which could impact the care of casualties who sustain GU trauma in the future.

Fertility Preservation Before Deployment: Oocyte and Sperm Freezing in Members of the Active Duty Military

“…A dramatic rise in the rate of GU injury was observed during the U.S. war efforts with Iraq and Afghanistan, primarily due to the heavy use of ground-based explosive devices. 54,55 Soldiers encountering these ground explosives often experienced dismounted complex blast injuries, a characteristic injury pattern involving multi-extremity damage or amputations, pelvic fractures, and genital/perineal injury. 56 With the advancements in emergency combat care, these historically fatal complex blast injuries became survivable, but often leaving the soldiers with significant genital and reproductive morbidities.…”

“…56 With the advancements in emergency combat care, these historically fatal complex blast injuries became survivable, but often leaving the soldiers with significant genital and reproductive morbidities. 54 While the majority of service members experiencing GU injury are men (98.5%), an increasing number of women are entering combat zones and experiencing injuries at similar rates as their male counterparts. 50 The largest review of military GU injuries was published at the conclusions of Operation Iraqi Freedom and Operation Enduring Freedom in 2017 by Janak et al 55 Over the 12 years and 30,000 injury codes analyzed through the Department of Defense Trauma Registry (DoDTR), 1,462 (5.3%) service members were reported to have sustained one or more GU injuries.…”

Postdeployment Fertility Challenges and Treatment in the Modern Era

“…In the late 19th and early 20th century conflicts, renal and bladder injury predominated over external genitourinary (GU) injuries. 2 However with OIF and OEF, body armor modifications, as well as a shift to overwhelming IED use by insurgents, a shift to lower urinary tract and genital trauma is occurring. 1,2 Historically, approximately 5% of wartime injuries were genitourinary in nature.…”

“…2 However with OIF and OEF, body armor modifications, as well as a shift to overwhelming IED use by insurgents, a shift to lower urinary tract and genital trauma is occurring. 1,2 Historically, approximately 5% of wartime injuries were genitourinary in nature. 4 Injuries to the bladder, urethra, and genital areas now constitute more than 80% of combat urologic injuries.…”

“…Thus, an unforeseen consequence of the decreased mortality rate after these complex blast injuries is a new wave of U.S. service members facing the challenges of recovering from catastrophic amputations and genitourinary injuries. 2…”