Urotrauma Concerns Troops

The report pointed to the increase in the number and severity of genitourinary injuries, particularly injury to the external genitalia. 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.

The task force recommended placing urologists at combat support hospitals to better address these injuries. In addition, they noted a general need for providers who can perform reconstruction.

“Currently, there are a limited number of [civilian and military] providers who perform phallic reconstructions surgery — thus indicating the need to train more military urologists and plastic surgeons in these techniques,” they wrote.

Their report also recommended that troops who sustain a dismounted complex blast injury, with or without genital injuries, should have access to fertility expert consultation as needed.

Caravalho also said research continues into “blast boxers,” which is armored underwear that may help prevent some of these injuries.

Some members of Congress are also examining what can be done to address genitourinary injuries in troops. Congressional legislation was introduced earlier this year to establish a National Commission on Urotrauma that would be lead by DoD and work with VA and HHS.

If the bill is passed, the Urotrauma Commission would “conduct a comprehensive study on urotrauma, as well as evaluate the public and private resources available for the diagnosis, prevention, treatment of, and research in this condition.” In addition, it would be tasked with working to identify programs to improve the management of urotrauma. The commission would also develop and recommend “a long-range plan for the use and organization of national resources, especially within the federal health programs, to effectively deal with urotrauma.

Karen Lencoski, federal manager in the American Urological Association’s Government Relations & Advocacy Department, said that it is important that the legislation is approved by Congress. Health problems such as incontinence, impotence and infertility are devastating, and young people who experience them often feel alone, she said.

“When it comes to these blast injuries that the [Army] report talks about, these are what I call ‘suffer in silence and shame kind of injuries’,” she told U.S. Medicine.

These injuries have huge ramifications on couples who may not be able to have normal sex lives or children as a result and may feel isolated in dealing with the injuries, she added.

“You just don’t find support groups for 25-year-olds who are now impotent or incontinent,” she added.

The American Urological Association has also appointed a special task force to study and make recommendations regarding genitourinary trauma for troops. The Army report said that the military would “play an important role on” that project.

“Part of this is, ‘How do we better prevent these injuries, but once these injuries occur what are we going to do to help put them back together?’” she said.          

Improving Prevention and Treatment

While troops may worry that nothing can be done for them if they sustain multiple limb loss and genital injuries, the report identified 92 recommendations to improve care. These recommendations included more aggressively treating pain at the point of injury, adding advanced-level medical staff to rotary wing evacuation platforms, improving prehospital medical care documentation, as well as putting urologists at combat support hospitals, among others.

The Army Surgeon General charged the Army Task Force “to validate anecdotal reports” from the battlefield that the severity of injuries in combat was increasing, Caravalho said.

“Our data would suggest that it is a matter of improved survivability of injury, even with the injuries being more severe in previous years,” he said.

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