Operative Management of Wartime Genitourinary Injuries at Balad Air Force Theater Hospital, 2005 to 2008

Abstract

Most genitourinary injuries treated at Balad Air Force Theater Hospital involve the lower genitourinary tract. The high frequency of genital trauma often requires staged reconstructive procedures. Acceptable renal and testicular salvage rates are attainable. This study highlights the diverse array of surgical treatment modalities needed to manage genitourinary trauma during Operation Iraqi Freedom.

Urotrauma: AUA Guideline

“…Wound management can include a variety of methods including gauze dressings with frequent changes, silver sulfadiazine or topical antibiotic and occlusive dressing, or negative pressure dressings. 159,161-163,167,171,175-179 Reconstructive techniques for definitive repair include primary closure and advancement flaps, placement of skin grafts, free tissue flaps, and pedicle based skin flaps. 161-163,165,166,170,180-185 …”

Urethral trauma. Part II: Types of injury and their management

“…Whereas exploration should always be undertaken, debridement may not be necessary because the genital skin and the corpora cavernosa and spongiosum are well vascularised [3][4][5][6][7][8][9][10][11], as is the posterior urethra on the rare occasions it is injured by gunshot wounds [4]. The only repair appropriate is suture closure or end-to-end anastomosis if these can be achieved without tension and this may not be possible [4].…”

“…War wounds throughout the ages [5][6][7][8][9][10][11] are interesting but very uncommon. The more recent the conflict the worse the injuries (sometimes with appalling injuries, particularly since the introduction of land mines) but the better the medical care so the more likely the injured are to survive.…”

Complex lower genitourinary reconstruction following combat-related injury

“…In Vietnam, the reported rate ranged from 3% to 4.2% 6. Hudak describes the experience of nine urologists in Iraq between 2005 and 20087; 273 patients sustained genitourinary injuries and 80% of these were of the lower genitourinary tract. Of these, 70% of those were to the external genitalia.…”