Management of combat-related urological trauma in the modern era

ABSTRACT Complex genitourinary injuries—associated with lower-extremity amputation as well as pelvic and abdominal wounding—have emerged as common occurrences in current military combat

operations. The nature of combat injuries of the genitourinary tract is varied, as are the strategies used in their management. For example, 5% of all combat injuries include wounds of the

urinary system or genitalia. For injuries that are predominantly penetrating in nature, immediate care requires the judicious preservation of viable tissue. Once the patient is stable,

urethral, corporal and testicular lacerations are closed primarily, whereas soft tissue injuries are re-approximated in a delayed fashion. Negative-pressure dressings have been a useful aid

in wound management; wound coverage is most commonly completed with split-thickness skin grafts and local flaps. Complex penile and urethral reconstructions are often delayed so orthopaedic

injuries can heal and the patient can manage activities of daily living. Final reconstruction requires a urologist with a full understanding of reconstructive techniques. KEY POINTS * Lower

extremity, pelvic, urogenital and abdominal injuries—collectively 'dismounted complex battle injury'—is an increasing issue in current US military operations owing to the use of

improvised explosive devices (IEDs) * IEDs and artillery shells can impart injury through both high-velocity and low-velocity projectiles, depending on the victim's proximity to the

explosion and the type of personal protective equipment worn * US military medical operations have prioritized bringing surgical resources far forward on the battlefield, which has enabled

patients to survive more-catastrophic injuries despite complex wounds that require extensive reconstruction * Discrete debridement is key in complex genitourinary wounds sustained in combat,

with delayed reconstruction once the patient is stable and has progressed well in rehabilitation * The profound psychological impact of these catastrophic injuries requires further

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our FAQs * Contact customer support SIMILAR CONTENT BEING VIEWED BY OTHERS RECONSTRUCTIVE SURGERY OF THE SCROTUM: A SYSTEMATIC REVIEW Article 11 October 2021 VASCULARIZED COMPOSITE

ALLOTRANSPLANTATION OF THE PENIS: CURRENT STATUS AND FUTURE PERSPECTIVES Article 28 October 2021 NO DIFFERENCE BETWEEN SPLIT-THICKNESS AND FULL-THICKNESS SKIN GRAFTS FOR SURGICAL REPAIR IN

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preliminary report of penile transplantation. _Eur. Urol._ 50, 851–853 (2006). Article  Google Scholar  Download references AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Department of

Urology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, 2nd Floor, Building 9, Bethesda, 20889, MD, USA Molly Williams & James Jezior Authors * Molly Williams View

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CONTRIBUTIONS Both authors researched the data for the article, discussed the article content, wrote the manuscript and edited it before submission. CORRESPONDING AUTHOR Correspondence to

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ARTICLE Williams, M., Jezior, J. Management of combat-related urological trauma in the modern era. _Nat Rev Urol_ 10, 504–512 (2013). https://doi.org/10.1038/nrurol.2013.148 Download

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