2017 Issues   /   Urology

Battlefield Genitourinary Damage Alters Lives Beyond Physical Injuries

USM By U.S. Medicine
March 10, 2017

Delayed Impact

Sgt. Ed Matayka and his wife, Karen, hold their twins, Alana Marie and Ryan David, at San Antonio Military Medical Center neonatal intensive care unit in 2013. At the time, Matayka was the first wounded warrior who had successfully had the in vitro fertilization transfer procedure. Army photo by Robert Shields

For many of the soldiers and marines in the study, the full impact of their injuries did not become apparent until years later. “The scrotum and testes are the most-common areas of injury, making fertility a challenge, but it often not an issue right away,” Hudak pointed out. “We may see patients a decade later, and they are only now thinking about childbearing. That’s making us consider the longitudinal impact on fertility.”

Patients who had severe blast injury to the pelvis may also suffer testicular atrophy and infertility, without any overt testicular injury, study author noted.

Under a new pilot program, current servicemembers can bank their gametes prior to deployment. Post-injury sperm salvage is also an option and is the standard of care for British servicemembers with testicular injuries today. For those rendered infertile as a result of GU injuries in OEF and OIF, however, the only option for paternity is donor sperm, which previously has not been a covered benefit.

Aside from reproduction, GU injuries might also result in loss of sexual function. While only five of the men in the TOUGH study suffered total penile loss, reconstructive surgery left some of the men who had suffered the most-severe penile injuries with a disfigured or nonfunctional phallus. The authors suggest that deceased donor penile transplantation and regenerative medicine approaches could be worth exploring to help servicemembers who suffer these injuries in the future.

Beyond the severity of the GU injuries themselves, recovery can be complicated by the constellation of other injuries with which they often occur, including traumatic brain injury (40.2%), lower extremity amputation (28.7%), pelvic fracture (24%) and colorectal injury (21.7%).

For polytrauma patients, in particular, “we’ve told them, ‘Get better first, worry about sex and intimacy later.’,” Hudak said. “For those who have more severe anatomy-altering injuries, having someone who can talk about the injuries with the servicemember and their partner would significantly improve care.”

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