2013 Issues   /   Urology

Advocates Seek Better Care for Urotrauma Wounds, Including Fertility Treatments

USM By U.S. Medicine
July 5, 2013

By Sandra Basu

WASHINGTON — Extremity loss, traumatic brain injury and eye injury each have their own DoD center of excellence, but urotrauma has not received the same policy attention and care coordination as those other types of common injuries, a urologist told a subcommittee of the House Committee on Veterans’ Affairs Committee.

“The cumulative physical and psychological impact of urotrauma on these soldiers is no less profound than for those recovering from extremity loss and neurocognitive injury,” Mark T. Edney, MD, an Army reservist and a member of the Legislative Affairs Committee and Urotrauma Task Force for the American Urological Association, told lawmakers.

Edney was among several advocates urging lawmakers in recent months to support bills that would assist veterans who have suffered urotrauma and fertility problems due to severe battlefield injuries.

Mark T. Edney, MD, talks to patients at Peninsula Regional Medical Center in Salisbury, MD. He testified before Congress about urotrauma in war wounded. Photo from Peninsula Regional Medical Center Facebook page.

Genitourinary (GU) injuries sustained in battle have come under greater scrutiny, particularly since a 2011 Army report stated that, at Landstuhl Regional Medical Center, the GU injury incidence among U.S. casualties was 19% in October of 2010, 10% in November 2010 and 13% in December of 2010.

Edney told the House subcommittee that the rate of genitourinary injury suffered by troops is up 350% in Afghanistan, compared to the Iraqi theater, as a result of the increased necessity of dismounted patrol. He said that although GU-injured veterans may exhibit no outward signs of their injury, they suffer “life-changing loss of proper sexual, bowel, and urinary function and fertility.” 

Fertility Legislation

One bill under consideration would expand the reproductive treatment and care options available to severely wounded veterans, including in vitro fertilization (IVF) provided through the VA. The bill also would make an eligible family member or surrogate of a severely wounded veteran eligible for the same fertility treatment as a veteran.

Sen. Patty Murray, (D-WA), reintroduced the bill this year after it failed to pass last year.

Supporters of the bill point out that VA currently does not offer IVF to veterans or their spouses while DoD and the TRICARE program already provide advanced fertility treatments, including assisted reproductive technology, to troops with complex injuries.

Rick Weidman, executive director for Policy and Government Affairs for Vietnam Veterans of America, told the Senate Committee on Veterans’ Affairs subcommittee that his organization is “strongly” in support of this legislation. In written testimony, he explained that the need to address fertility and procreation problems “has been apparent for many years,” and this proposal is “a good and comprehensive approach to this problem for both male and female veterans.”

The VA, however, only supports portions of the bill.

VHA Principal Deputy Undersecretary for Health Robert L. Jesse, MD, PhD, told the committee that if additional resources were to be provided, VA would make fertility counseling and treatment available, including treatment using assisted reproductive technology. VA would only support providing these services to severely wounded, ill or injured enrolled veterans and their spouses or partners, not to surrogates, as called for in the bill.

“The complex legal, medical and policy arrangements of surrogacy vary from state to state due to inconsistent regulations between states, and we believe would prove to be very difficult to implement in practice,” according written testimony from Jesse.

Urotrauma Research

Also under consideration is a bill introduced by Rep. Brett Guthrie (R-KY) that directs the Secretary of Defense to establish a task force to conduct a study of urotrauma among troops and veterans.  Guthrie said he believed that efforts to address urotrauma research throughout the government were not well coordinated.

“I believe that many skilled professionals are hard at work on the issue, but as is often the case in government their efforts are divided, unintegrated and, because of this, less effective,” he said during a House subcommittee hearing. “By my tally, there are six government agencies currently working on urotrauma, and, while I’m heartened that this research is occurring, I’m discouraged that there seems to be little dialogue or centralization of information. Put simply, we aren’t learning from experience and if we are, we’re learning too slowly.”

Edney, who testified in support of the bill, said it “prescribes the comprehensive study required to address the variety of opportunities for improving the prevention, initial management, care coordination and research of this devastating and increasingly prevalent pattern of injury.”

Iraq and Afghanistan Veterans of America Legislative Director Alex Nicholson said his organization supports the bill.

“While the number of urotrauma injuries has continued to rise, the body of knowledge on and available treatment options for these injuries have remained relatively stagnant,” he said in written testimony.

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