Genitourinary Injuries Research Articles

MP79-13 GENITOURINARY INJURY IN MALE VETERANS RECEIVING VA HEALTH CARE: THE IMPORTANCE OF LINKING DOD AND VA DATA

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) I1 Apr 2017MP79-13 GENITOURINARY INJURY IN MALE VETERANS RECEIVING VA HEALTH CARE: THE IMPORTANCE OF LINKING DOD AND VA DATA Steven Hudak, Jean Orman, Megan Amuan, Mary Jo Pugh, Nina Nnamani, Douglas Soderdahl, Judson Janak, and Michael Liss Steven HudakSteven Hudak More articles by this author , Jean OrmanJean Orman More articles by this author , Megan AmuanMegan Amuan More articles by this author , Mary Jo PughMary Jo Pugh More articles by this author , Nina NnamaniNina Nnamani More articles by this author , Douglas SoderdahlDouglas Soderdahl More articles by this author , Judson JanakJudson Janak More articles by this author , and Michael LissMichael Liss More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2497AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Outcomes of military genitourinary injuries (GUI) have not been well-studied. Although US servicemen with GUI sustained during Operations Iraqi and Enduring Freedom (OIF/OEF) have been identified separately in the Department of Defense Trauma Registry (DoDTR) and VA electronic medical records, no previous studies have linked DoD and VA data to investigate outcomes in the population of Veterans with combat deployment-related GUI. METHODS VA electronic medical records were searched for male OIF/OEF Veterans receiving VA care at least once between 1 October 2001 and 30 September 2011. VA records were linked with DoDTR records for male US service members injured while deployed to OIF/OEF during the same time period. Variables extracted from the DoDTR included type of GUI, severity of GUI, and Injury Severity Scores (ISS). Outcome diagnoses from VA electronic medical records included sexual dysfunction, urinary symptoms, and neuropsychiatric conditions. Injury characteristics and prevalence of outcomes among those with and without GUI were compared. RESULTS Of the 12,923 injured male OIF/OEF Veterans identified in both VA electronic medical records and the DoDTR, n=591 (4.6%) had a diagnosis of combat deployment-related GUI in the DoDTR. Of note, only 3.0% of patients with a GUI diagnosis in the DoDTR also had a GUI diagnosis documented in VA medical records. The 591 patients with GUI were injured early in OIF/OEF, with 80.0% injured before 2008. A total of 30.3% had severe GUI. Overall injury severity was greater (ISS ≥ 16: 58.5% vs. 14.9%; p<0.01) and the prevalence of both urinary symptoms (6.3% vs. 3.1%; p<0.01) and sexual dysfunction (13.5% vs. 7.1%; p<0.01) higher among those with GUI vs. without GUI, respectively. Traumatic brain injury prevalence was higher among those with vs. without GUI (48.0 % vs. 40.0%; p<0.01) and post-traumatic stress disorder (PTSD) was common among both groups (51.6% vs. 50.6%; p=0.64). CONCLUSIONS A minority of VA patients with GUI sustained during OIF/OEF have GUI documented in their VA medical record. However, VA patients with GUI have substantially higher rates of urinary and sexual problems treated at VA facilities. Thus, comprehensive care for OIF/OEF Veterans could be improved with better documentation of GUI upon transfer from DoD to VA care. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1077 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Steven Hudak More articles by this author Jean Orman More articles by this author Megan Amuan More articles by this author Mary Jo Pugh More articles by this author Nina Nnamani More articles by this author Douglas Soderdahl More articles by this author Judson Janak More articles by this author Michael Liss More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP30-01 PENIS TRANSPLANTATION: FIRST U.S. EXPERIENCE

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery II1 Apr 2017MP30-01 PENIS TRANSPLANTATION: FIRST U.S. EXPERIENCE Dicken Ko, Kai Li, Harry Salinas, Ilse Schol, Branko Bojovic, Kyle Eberlin, Jonathan Winograd, Jeffrey Lee, Garry Choy, Raymond Liu, Ivy Rosales, Michael Grant, Francis McGovern, Adam Feldman, Cigdem (Cori) Tanrikut, Robert Colvin, and Curtis Cetrulo Dicken KoDicken Ko More articles by this author , Kai LiKai Li More articles by this author , Harry SalinasHarry Salinas More articles by this author , Ilse ScholIlse Schol More articles by this author , Branko BojovicBranko Bojovic More articles by this author , Kyle EberlinKyle Eberlin More articles by this author , Jonathan WinogradJonathan Winograd More articles by this author , Jeffrey LeeJeffrey Lee More articles by this author , Garry ChoyGarry Choy More articles by this author , Raymond LiuRaymond Liu More articles by this author , Ivy RosalesIvy Rosales More articles by this author , Michael GrantMichael Grant More articles by this author , Francis McGovernFrancis McGovern More articles by this author , Adam FeldmanAdam Feldman More articles by this author , Cigdem (Cori) TanrikutCigdem (Cori) Tanrikut More articles by this author , Robert ColvinRobert Colvin More articles by this author , and Curtis CetruloCurtis Cetrulo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.934AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Penis transplantation represents a new paradigm in restoring anatomic appearance, urine conduit, and sexual function following genitourinary tissue loss. Genitourinary injuries and diseases that result in partial or complete penile loss have devastating functional and emotional consequences for patients leading to significant mental health sequelae, including depression and suicide. To date, only two penis transplants have been performed worldwide. We describe the 6 month follow up of the first successful penis transplant in the United States in a patient with a history of subtotal penectomy for penile cancer. METHODS Following Institutional Review Board approval, extensive medical, surgical, and radiological evaluations of the patient were performed. His candidacy was reviewed by an multidisciplinary team of surgeons, physicians, psychiatrists, social workers, and nurse coordinators. After an appropriate donor was identified by United Network for Organ Donation, allograft procurement and recipient preparation took place concurrently. Anastomoses of the urethra, corpora, cavernosal and dorsal arteries, dorsal vein, and dorsal nerves were performed as well as inclusion of a donor skin pedicle as the composite allograft. Immunosuppression consisted of antithymocyte globulin induction, mycophenolate mofetil, and methylprednisolone, and tacrolimus. RESULTS Postoperatively, the allograft had an excellent capillary refill and strong Doppler signals. Operative interventions on postoperative days 2 and 13 were required for hematoma evacuation and debridement of maturing skin eschar. At 3 weeks, no anastomotic leaks were detected on peri-catheter urethrogram and the catheter was removed. The patient developed one episode of steroid-resistant rejection (Banff III) which required a repeat course of methylprednisolone and antithymocyte globulin. At 6 months, the patient has recovered partial sensation of the penile shaft and has spontaneous penile tumescence. Our patient reports increased overall health satisfaction, dramatic improvement of self-image, and optimism for the future. CONCLUSIONS We have shown that it is feasible to perform penile transplantation with excellent results. Furthermore, this experience demonstrates that penile transplantation can be successfully performed with conventional immunosuppression. We propose that our penile transplantation pilot experience with encouraging short-term results represents a proof of concept that establishes a new and emerging field in reconstructive transplantation. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e389 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Dicken Ko More articles by this author Kai Li More articles by this author Harry Salinas More articles by this author Ilse Schol More articles by this author Branko Bojovic More articles by this author Kyle Eberlin More articles by this author Jonathan Winograd More articles by this author Jeffrey Lee More articles by this author Garry Choy More articles by this author Raymond Liu More articles by this author Ivy Rosales More articles by this author Michael Grant More articles by this author Francis McGovern More articles by this author Adam Feldman More articles by this author Cigdem (Cori) Tanrikut More articles by this author Robert Colvin More articles by this author Curtis Cetrulo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Different Aspects of Penile Amputation; Surgery, Forensics, and Psychiatry (Case Report and Short Review)

Penile amputation (PA) is a rare genitourinary injury. Three main etiologies of PA consist of iatrogenic, accidental, and self-mutilation. Eighty-seven percent of the self-mutilated patients suffer from psychiatric disorders. Nowadays, microsurgical techniques with neurovascular anastomosis are the best approach for PA. This paper insists on psychiatric and legal consequences, which may involve health-care team. A 25-year-old male patient presented to our emergency department with self-inflicted PA. As he had a history of some psychiatric problems, psychiatric consultation was requested. The patient did not accept any surgical interventions. We informed his relatives completely; however, they did not agree with surgical intervention because they predicted that he might repeat amputation again. According to the forensic medicine specialist consultation, we took the coroner's warrant for emergency surgical intervention and transferred the patient to the operating room without any consent. Microsurgical penile replantation was performed. There was no leakage in retrograde pericatheter urethrography on the 3rd postoperative week, and the urethral catheter was removed. The patient was able to void normally, and cystostomy tube was removed at the same time. Consent for all medical procedures is an important part of national and international human right law and medical ethics. Physicians should inform patients about their problem and take a reliable consent. If the patient was unreliable for informed consent, relatives could do it. However, in an emergency, there is an exception in the law that let surgeons do the operation without consent for these cases.

Lower urinary tract imaging in pelvic fracture: an 11-year review of genitourinary complications and clinical outcomes.

Diagnostic cysto-urethrogram (CUG) is accepted as the standard of imaging for lower urinary tract (LUT) injuries in patients with pelvic fracture. This study evaluates the prevalence of LUT trauma and adequacy of diagnostic CUG in the initial assessment of patients with pelvic fractures. A retrospective review on all patients admitted with pelvic trauma between 2002 and 2012 was undertaken following ethics approval. Patient demographics such as pelvic fracture pattern, genitourinary injury, diagnostic imaging tests and clinical outcomes were reviewed. A total of 99 patients were identified during the 11 years. Nine patients were excluded due to prior LUT imaging at another hospital. Of the 90 patients, macroscopic haematuria was present in 63 patients (70%), and LUT injury was diagnosed in 42 patients (46.6%). LUT imaging was performed in 30 patients (33.3%) - four patients with urethrogram alone, 17 had cystogram alone and nine patients underwent CUG. An oblique view was included in five of 20 studies (25%) performed with direct fluoroscopy. Adequate bladder filling was present in 17 of 26 bladder imaging studies (65.3%). LUT injury was missed in seven of 90 patients (7.8%) due to the absence of imaging. This consisted of one patient with urethral injury and six patients with bladder injury, all of whom experienced delays in treatment. Long-term genitourinary dysfunction was present in three of seven patients with delayed diagnosis. Incomplete CUG in the assessment of pelvic fracture can result in treatment delay and genitourinary dysfunction.

The Ethics of Penile Transplantation: Preliminary Recommendations.

For men with significant genitourinary injury, penile transplantation is being considered as an option when reconstruction is not feasible or proves unacceptable to the injured patient. A review of the literature was conducted to assess the current state of penile reconstruction and transplantation options, as well as to evaluate scholarly research addressing the ethical dimensions of penile transplantation. The state of penile transplantation is elementary. If reconstruction is not a possibility, proceeding ethically with research on penile vascularized composite allotransplantation will require the articulation of guidelines. To date, very little has been published in the scholarly literature assessing the ethics of penile transplantation. Guidelines should be developed to address penile transplantation and must cover the donation of tissue, consent, subject selection, qualifications of the surgical team, and management of both failure and patient dissatisfaction. Unless guidelines are established and disseminated, penile transplants should not be undertaken. The preliminary recommendations suggested in this article may help to inform development of guidelines.

Genitourinary injuries and extremity amputation in Operations Enduring Freedom and Iraqi Freedom

In Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF), genitourinary (GU) wounds have occurred in unprecedented numbers. Severe concomitant injuries, including extremity amputations, are common. The epidemiology of GU injury and extremity amputation in OEF/OIF has not been described. The Department of Defense Trauma Registry was queried from October 2001 through August 2013 to identify all surviving US male service members with GU injuries sustained in OEF/OIF. Genitourinary injury was defined as sustaining one or more injuries to any organ or structure within the genitourinary and/or reproductive system(s) based on International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Injury severity was quantified based on Abbreviated Injury Scale scores and overall Injury Severity Scores. The incidence, nature, and severity of GU injuries and extremity amputations are described. Of the 1,367 service members with GU injury included in this analysis, 433 (31.7%) had one or more extremity amputations. Most GU injuries were to the external genitalia [scrotum (55.6%), testes (33.0%), penis (31.0%), and urethra (9.1%)] vs. the kidneys (21.1%). Those with amputation(s) had greater GU injury severity (Abbreviated Injury Scale score ≥ 3) than those without amputations (50.1% vs. 30.5%, respectively; p < 0.0001). Approximately 3.4% of male service members with GU injury had an upper extremity amputation only, 8.9% had both lower and upper extremity amputation(s), and 19.4% had lower extremity amputation(s) only. Of the 387 patients with GU injury and lower extremity amputations, 87 (22.5%) had amputations below the knee and 300 (77.5%) had amputation(s) at/above the knee. In OEF/OIF, concomitant GU injury and extremity amputation are common and have serious implications for health and quality of life. This wounding pattern presents new challenges to the military medical and research and development communities to prevent, mitigate, and treat these battlefield injuries. Epidemiologic/prognostic study, level III.

Military Genitourinary Trauma: Policies, Implications, and Ethics.

The men and women who serve in the armed forces, in the words of Major General Joseph Caravalho, "sign a blank check, co-signed by their families, payable to the Army, Navy, Air Force, or Marines, up to and including their lives." It is human nature to consider such a pact in polarized terms; the pact concludes in either a celebratory homecoming or funereal mourning. But in reality, surviving catastrophic injury may incur the greatest debt. The small but real possibility of losing the ability to bear biological children due to genitourinary combat injury has been a topic of discussion in hushed tones, behind closed doors. But as policy changes move the conversation into the open, we must be fully aware of the far-reaching and long-term impacts of decisions on those who have sustained genitourinary injury. In January 2016, Secretary of Defense Ashton Carter outlined a set of reforms that would improve the quality of life for military families by recognizing the importance of maintaining fertility, even in the face of severe injury. This first promising step could build a solid foundation of insuring fertility preservation for wounded service members with genitourinary injury, and it could set a precedent beyond the military for insuring treatment for people who have lost their reproductive capacity. Thus, the ethical challenges raised by the new policy require careful analysis.

Suprapubic Catheter Placement in Lower Genitourinary Tract Injury: Friend or Foe?

Suprapubic Catheter Placement in Lower Genitourinary Tract Injury: Friend or Foe?

Post-traumatic urethrocutaneous fistula with pelvic fracture in a boy: A case report and literature review

Traumatic genitourinary injuries especially urethral injuries are rare in children. Most of these injuries occur in conjunction with a pelvic fracture after blunt trauma. These injuries call for an immediate diagnosis and appropriate management. Good results have been reported after delayed repair. However, urethral stricture, incontinence and erectile dysfunction are the known complications. We report a traumatic urethral injury causing urethrocutaneous fistula in a seven year boy.

English

This study aimed to conduct an ethnobotanical survey of medicinal species in an &aacute;rea of cerrado vegetation in the chapada do Araripe, Ceara, as well as evaluating and selecting species with potential for bioprospecting, based on the relative importance of the species and the consensus among the informants. The ethnobotanical data were collected through semi-structured interviews and a free list, and by using the technique &quot;snowball&quot;. It was analyzed the relative importance of the mentioned plants as well as species that stood out on the bodily systems, based on the factor:consensus among the informants. It was recorded a total of 38 species distributed into 35 genera and 25 families. Of the total eight species (21%) presented great versatility (IR&ge;1) regarding to its use. The therapeutic indications were grouped into 14 categories of bodily systems.&nbsp; Disorder of respiratory and genitourinary systems, injuries, poisoning and other consequences of external causes and diseases of the blood, organs and connective tissue, obtained a greater consensus among the informants. Ximenia americana, Himathantus drasticus, Stryphnodndron rotundifolium, Hancornia speciosa and Cecropia pachysthachya were the species subject to further study, based on versatility, and consensus of the use among the informants. Key words: Ethnobotany, factor in consensus, local knowledge, potential therapeutic, regional species, relative importance.

Epidemiology of Genitourinary Injuries among Male U.S. Service Members Deployed to Iraq and Afghanistan: Early Findings from the Trauma Outcomes and Urogenital Health (TOUGH) Project

In this study we report the number, nature and severity of genitourinary injuries among male U.S. service members deployed to Operations Iraqi Freedom and Enduring Freedom. This retrospective cross-sectional study of the Department of Defense Trauma Registry used ICD-9-CM codes to identify service members with genitourinary injuries, and used Abbreviated Injury Scale codes to determine injury severity, genitourinary organs injured and comorbid injuries. From October 2001 to August 2013, 1,367 male U.S. service members sustained 1 or more genitourinary injuries. The majority of injuries involved the external genitalia (1,000, 73.2%), including the scrotum (760, 55.6%), testes (451, 33.0%), penis (423, 31%) and/or urethra (125, 9.1%). Overall more than a third of service members with genitourinary injury sustained at least 1 severe genitourinary injury (502, 36.7%). Loss of 1 or both testes was documented in 146 men, including 129 (9.4%) unilateral orchiectomies and 17 (1.2%) bilateral orchiectomies. Common comorbid injuries included traumatic brain injury (549, 40.2%), pelvic fracture (341, 25.0%), colorectal injury (297, 21.7%) and lower extremity amputations (387, 28.7%). An unprecedented number of U.S. service members sustained genitourinary injury while deployed to Operation Iraqi Freedom/Operation Enduring Freedom. Further study is needed to describe the long-term impact of genitourinary injury and determine the potential need for novel treatments to improve sexual, urinary and/or reproductive function among service members with severe genital injury.

Major genitourinary-related bicycle trauma: Results from 20 years at a level-1 trauma center

BackgroundEpidemiological studies have shown that bicycle trauma is associated with genitourinary (GU) injuries. Our objective is to characterize GU-related bicycle trauma admitted to a level I trauma center. Materials and methodsWe queried a prospective trauma registry for bicycle injuries over a 20-year period. Patient demographics, triage data, operative interventions and hospital details were collected. ResultsIn total, 1659 patients were admitted with major bicycle trauma. Of these, 48 cases involved a GU organ, specifically the bladder (n=7), testis (n=6), urethra (n=3), adrenal (n=4) and/or kidneys (n=36). The median age of cyclists with GU injuries was 29 (range 5–70). More men were injured versus women (35 versus 13). GU-related bicycle trauma involved a motor vehicle in 52% (25/48) of injuries. The median injury severity score for GU-related bicycle trauma was 17 (range 1–50). The median number of concomitant organ injuries was 2 (range 0–6), the most common of which was the lungs (13/48, 27%) and ribs (13/48, 27%). The majority of GU injured cyclists were admitted to an ICU (15/48, 31%) or hospital floor (12/48, 25%). Operative intervention for a GU-related trauma was low (12/48, 25%). The most common GU organ injured was the kidney (36/48, 75%) however most were managed nonoperatively (33/36, 92%). Bladder injuries most often required operative intervention (6/7, 86%). Mortality following GU-related bicycle trauma was low (2/48, 4%). ConclusionsIn a large series of bicycle trauma, GU organs were injured in 3% of cases. The majority of cases were managed non-operatively and mortality was low.

Animal bite of genitalia in a child: A rare case of anterior urethral injury

Pediatric genital injuries are relatively uncommon. Urethral injuries occur in 3.4% of genitourinary injuries in children. The majority of urethral injuries in boys are to the anterior urethra. We review the diagnosis and management of anterior urethral injuries in the setting of a dog bite to the genitalia in child.

A negative urinalysis is associated with a low likelihood of intra-abdominal injury after blunt abdominal trauma

BackgroundThe utility of urinalysis (UA) to diagnose intra-abdominal (IA) or genitourinary (GU) injury after blunt trauma remains controversial. The purpose of this study was to determine the significance of UA in the blunt trauma patient. MethodsA retrospective review of patients admitted for blunt abdominal trauma from 2011 to 2013. ResultsA total of 1,795 patients sustained blunt abdominal trauma: mean age of 44 ± 21 years; mean Injury Severity Score of 13 ± 10. Overall 810 patients had a negative UA (45%). Two patients (2/810 and .2%) had a GU injury and neither required intervention. Thirty-two patients (32/810 and 4.0%) had an IA injury, and 2 (2/810 and .02%) required intervention. The sensitivity for predicting GU injury requiring intervention was 1, and IA injury requiring intervention was .96. Negative predictive values were 1 and .99. ConclusionsA negative UA correlates with a low risk for GU and IA injury after blunt abdominal trauma. A negative UA should be evaluated prospectively as part of a clinical prediction score to rule out injury and avoid unnecessary radiation exposure from computed tomography imaging.

Robotic-Assisted Gynecologic Surgery and Perioperative Morbidity in Elderly Women

Study ObjectiveTo assess perioperative complications, conversions, and operative times in patients age ≥75 years undergoing robotic-assisted gynecologic surgery. DesignRetrospective cohort study (Canadian Task Force classification II-2). SettingHigh-volume, 2-physician gynecologic oncology practice. PatientsA total of 705 women who underwent any robot-assisted gynecologic procedure for benign (n = 380) or malignant (n = 325) conditions between July 2008 and May 2014. Fifty patients age ≥75 years (elderly group) were compared with 655 patients age <75 years (younger group). InterventionsOperative data were gathered prospectively for all robotic-assisted procedures. Demographic and perioperative outcomes were analyzed retrospectively for this study. Measurements and Main ResultsThe mean age was 81.3 ± 4.2 years (range, 75.0–90.5 years) in the elderly group and 52.8 ± 11.5 years (range, 22.9–74.6 years) in the younger group. The elderly group had higher rates of surgery for malignancy (90.0% vs 43.2%; p < .01) and lymphadenectomy (44.0% vs 23.4%; p < .01), and was more likely to have cardiovascular disease (88.0% vs 37.6%; p < .01). There were no between-group differences in body mass index or history of chronic obstructive pulmonary disease, diabetes mellitus, or more than 1 previous abdominal surgical procedure. The elderly group was more likely to have a length of stay greater than postoperative day one (30.0% vs 14.8%; p = .01) and had a higher incidence of postoperative cardiac arrhythmia (8.0% vs 1.2%; p < .01). The elderly group also had a smaller median uterine size (83.0 ± 49.1 g vs 126.0 ± 189.5 g; p < .01), but total operative time, rate of conversion (6.0% vs 1.8%) and rate of blood transfusion (2.0% vs 1.5%) were not significantly different between the 2 groups. Rates of bowel and genitourinary injury were <1% in both groups, and there was no between-group difference in postoperative infectious morbidity, vaginal cuff complications, or reoperation. ConclusionThe perioperative complication rates of robotic-assisted surgery are comparable in elderly women and younger women, despite a longer hospital length of stay and greater likelihood of postoperative arrhythmia in elderly women.

FRII-02 THE MANAGEMENT OF GENITOURINARY TRAUMA IN WORLD WAR II

You have accessJournal of UrologyHistory of Urology: History Forum II1 Apr 2016FRII-02 THE MANAGEMENT OF GENITOURINARY TRAUMA IN WORLD WAR II Joseph Sterbis, Ronald Caras, John Musser, and Ryan Speir Joseph SterbisJoseph Sterbis More articles by this author , Ronald CarasRonald Caras More articles by this author , John MusserJohn Musser More articles by this author , and Ryan SpeirRyan Speir More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2923AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES During the course of World War II, the United States lost over 400,000 service members, with more than 600,000 wounded. Genitourinary injury accounted for approximately 0.5% of those wounded. Our intent is to review the injuries and treatment modalities from that time, allowing for contemporary comparison. METHODS Primary and secondary literature sources were reviewed from World War II and the post-war era. These sources were surveyed to determine the organ-specific incidences of injury, the nature of combat-related genitourinary trauma, and the surgical and medical therapies utilized in both forward and rear echelons. RESULTS Reports of organ-specific injury rates demonstrate varied incidences: Kidney: 25-40%, External Genitalia: 30-56%, Bladder: 12-15%, Ureter: 1-3%. Reports following the war that discuss treatment modalities focus on immediate control of hemorrhage, urinary drainage, and infection control. Preoperative imaging of the kidney was considered of great importance when feasible, with authors recommending a one-shot intravenous pyelogram as a minimum. Conservative management of blunt renal trauma was advocated. Renorraphy was performed when feasible in penetrating trauma. Vascular repair was also considered, though no reported cases were identified. Upper ureteral injuries were managed with early repair over a catheter, while lower injuries were reimplanted. The Davis intubated ureterotomy, first reported in 1946, was advocated as a means for management of post-traumatic stricture. Extraperitoneal bladder injuries were managed conservatively or with repair if surgery for other injuries was planned. Intraperitoneal bladder injuries were managed with repair and suprapubic cystostomy. Posterior urethral injuries were managed via suprapubic diversion and early surgical approximation, the nature of which was ill-defined. Neurogenic bladder from spinal cord injury was generally managed with suprapubic cystostomy, with authors very clear that such injuries were not to be managed with intermittent catheterization. CONCLUSIONS With this year marking the 71st anniversary of the conclusion of World War II, review of historic data provides perspective informing our contemporary combat trauma management. With the notable exception of neurogenic bladder, many management principles have been preserved over time. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e521 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Joseph Sterbis More articles by this author Ronald Caras More articles by this author John Musser More articles by this author Ryan Speir More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Genitourinary trauma in geriatric patients.

The geriatric population is the fastest growing segment of the population, and geriatric trauma patients are increasingly common. Caring for this population has unique challenges. The goal of the review is to identify factors that may help in the care of geriatric patients suffering from genitourinary trauma. Multiple factors lead to inferior outcomes in patients with geriatric trauma including failure to rescue, treatment in lower volume trauma centers, and undertriage of geriatric patients. Improvement in geriatric trauma outcomes occurs with the use of dedicated geriatric consult teams. The surgical management of genitourinary injuries in the geriatric population remains unchanged. Interventions for geriatric patients differ from younger populations. Direct changes in overall management of the geriatric population lead to improved outcomes. The treatment of geriatric trauma patients with genitourinary injuries is similar to a younger cohort. The lack of recent studies in clinical outcomes in this population has been identified as a gap in knowledge that will require future research to answer.

Long-term results of robotic sacral hysteropexy for pelvic organ prolapse in China Single medical center

ObjectiveTo evaluate the long-time clinical outcomes of robotic sacral hysteropexy for pelvic organ prolapse (POP). MethodsFive women who underwent robotic sacral hysteropexy for the treatment for POP. Blood loss, operative time, length of stay, blood transfusion, pulmonary embolus, gastrointestinal or genitourinary tract injury, ileus, bowel obstruction, post-operative fever, and urinary retention were recorded for all patients. ResultsAll the operative procedures were successfully performed using the robotic approach. In one case with perineal laceration, perineal repair was simultaneously performed, and in one patient with combined leiomyoma, myomectomy was performed first. The other three cases underwent no additional procedures during the surgery. Neither intra-nor post-operative complications occurred in all 5 cases. After follow-up one year, all patients declared their satisfaction with the achieved anatomical and functional results. ConclusionsThe robotic sacral hysteropexy is a minimally invasive technique for POP repair. We found low complication rates and high patient satisfaction with a minimum of 1 year followup. Larger series with longer follow-up data are needed to justify its widespread use.

Improvised explosive device-related lower genitourinary trauma in current overseas combat operations.

The use of improvised explosive devices (IEDs) has had a profound effect on battlefield trauma in the 21st century. Historically, wounds to the genitourinary (GU) structures have been less common than extremity and penetrating abdominal trauma in combat operations. GU injury incidence, severity, and associated injuries secondary to the use of this weapon in Operations Iraqi and Enduring Freedom has not been described. Data from the Department of Defense Trauma Registry was reviewed for combat-related GU injuries in Operations Iraqi and Enduring Freedom from 2001 to 2011. All wounded US armed service members are included in this database. Subjects were selected by a query of current procedural terminology and DRG International Classification of Diseases-9th Rev. codes related to traumatic injury of the penis, scrotum, testicles, and urethra. A retrospective chart review was performed for each patient to identify the date of injury, the mechanism of injury, and the associated traumatic wounds. Subjects' follow-up records were reviewed until present time or separation from active duty. A total of 501 soldiers sustained lower GU trauma, with a total of 729 injuries. Of these casualties, 448 (89%) were wounded by IEDs. Dismounted injuries (87%) made up more of the cohort than did vehicular. Specific trauma sites include 149 (20%) penile, 260 (36%) testicular, 284 (39%) scrotal, and 36 (5%) urethral injuries. The 180 limb amputations (36%) and 86 fractures (17%) were the most encountered concomitant skeletal wounds among service members with GU injuries. This is the first review of all lower GU trauma sustained by all US armed service members in current overseas combat operations. Combat-related lower GU trauma is primarily caused by IEDs in the spectrum of complex dismounted blast injuries. The mechanism primarily results in multisystem injury, with isolated GU involvement being uncommon. Continued evaluation of long-term sequelae, including sexual, urinary, and reproductive dysfunction, is needed. Epidemiologic study, level V.

Gunshot-associated Fractures in Children and Adolescents Treated at Two Level 1 Pediatric Trauma Centers.

Gunshot injuries are a potentially significant cause of morbidity and mortality in the pediatric population. The objective of this study was to evaluate the epidemiology, fracture locations, associated injuries, types of treatment, and complications of gunshot-associated fractures in children and adolescents treated at two level 1 trauma centers. The clinical and radiographic records of all children and adolescents who had a gunshot-associated fracture treated at 1 of 2 level 1 pediatric trauma centers between January, 2005, and April, 2013, were reviewed. The following characteristics were recorded: patient age and sex, type of weapon, fracture location, presence of neurovascular injury or other associated injuries, antibiotic treatment, method of stabilization, duration of hospital stay, complications, and need for subsequent procedures. Forty-nine patients with 58 fractures were identified; 9 patients had multiple fractures. The 41 males and 8 females had an average age of 12.2 years (range, 1 to 18 y). The tibia and femur were the most common sites of fracture (19% each), followed by the small bones of foot (4%) and the fibula (4%). Most of the fractures (71%) were treated nonoperatively. Nearly half (47%) of the patients had additional injuries, including abdominal or genitourinary injuries, neuropraxia or nerve injuries, and vascular injuries. Two patients (4%) developed infections (1 superficial and 1 deep) that required multiple irrigation and debridement procedures. Three patients developed compartment syndrome, and 4 patients had vascular injuries requiring repair. Nearly a third of patients (35%) had fractures or complications that required additional operative procedures. This large retrospective study highlights the significant morbidity of fractures caused by gunshots. Although the overall infection rate was low and most of these fractures were successfully treated nonoperatively, many of the patients required an additional operative procedure and nearly half had additional nonorthopaedic injuries. This emphasizes the necessity of coordination among emergency, general surgeons, intensivist, and orthopaedic surgical teams. Level IV—retrospective case series.