Andrew Siegel MD 8/26/17
Urological trauma (Urotrauma) is not uncommon among members of the USA military deployed in the Middle East. From October 2001-August 2013, approximately 1500 male soldiers suffered genital and/or urinary injuries. Most were external, involving the penis, scrotum, testicles and urethra. At least one-third of these external injuries were severe, with 150 men losing either one or both testicles. The increased survival following complex traumatic injuries, which in prior conflicts would have likely resulted in death, now often result in survival of men with severe injuries, including those of the urological system. These injuries significantly affected sexual, urinary and reproductive health.
Attribution of image above: By English: Sgt. Sean P. Casey, U.S. Army (www.defense.gov) [Public domain], via Wikimedia Commons
Improvements in battlefield medicine have significantly increased survival rates among injured soldiers. However, these improvements have resulted in unprecedented numbers of soldiers—who previously would have died—surviving with injuries. When traumatic injuries to the urinary and genital tract occur, they often result in urinary and sexual dysfunction, fertility issues and severe psychological trauma.
During the 12-year period under review, there were 30,000 injuries to deployed soldiers. 5% of soldiers sustained one or more urological injuries. The majority of the injured were junior enlisted and members of the US Army or US Marine Corps, under 30 years old. Most urological injuries occurred during battle and were predominately caused by explosive devices causing penetrating injuries. The scrotum was most commonly injured, followed by the testicles, penis, and urethra. Loss of the entire penis and/or one or both testicles occurred in about 150 men. The consequence of severe genital injury is often a shortened, disfigured, nonfunctional penis, even despite conventional reconstructive surgery. Commonly accompanying urological trauma are brain trauma, pelvic fracture, colon and rectal injury and lower extremity injuries resulting in amputation.
The current pattern of urological injury represents a shift from internal urological structures—including the kidney, ureter, and bladder—to external urological structures. This is attributed to the use of body armor that protects the chest and abdomen, but not the external genitals. Furthermore, the rugged terrain in Afghanistan exposes soldiers patrolling on foot to genital blast trauma from ground-based explosive devices. Traditionally, the protective clothing to minimize genital trauma from ground-based explosive high-energy projectiles devices is a lightweight boxer brief undergarment and a thicker brief-type outer garment that is worn over combat trousers. The US Army has introduced a new “pelvic protector” designed to shield the soldier’s genital and perineal areas from debris generated by improvise explosive devices.
Bottom Line: Male external genitals were the predominant structures injured in recent warfare. Severe testicular and/or penile injury occurred in a substantial portion of the soldiers, with urological injuries often accompanying general body trauma. Sadly, most injuries—many of which are disfiguring genital injuries—occur at the time of peak sexual and reproductive potential, negatively affecting relationships and paternity. Fortunately, advances in injury prevention, organ reconstruction/replacement, penile transplantation, regenerative medicine and advanced sperm salvage have the potential of making a significant difference in the health and well-being of soldiers with significant genital/urinary trauma.
Resource for this entry: “Epidemiology Of Genitourinary Injuries Among Male United States Service Members Deployed To Iraq And Afghanistan: Early Findings From The Trauma Outcomes And Your General Health Project” J Janak, J Orman, D Soderdahl and S Hudak, Journal of Urology: Volume 197, pages 414 – 419, February 2017
Wishing you the best of health,
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Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery. Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.
Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health
Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Healt
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