Kronstedt Shane, Wahlstedt Eric, Blacker Mason, Saffati Gal, Hinojosa-Gonzalez David E, Wilbert Hance, Fetherston Thomas, Friedman Jonathan, Mucher Zachary R
Department of Urology, Baylor College of Medicine, Houston, TX 77030-3411, USA.
University of Kentucky School of Medicine, Lexington, KY 40506-0107, USA.
Mil Med. 2025 Jan 16;190(1-2):e82-e89. doi: 10.1093/milmed/usae341.
Genitourinary (GU) trauma resulting from combat and the treatment of these injuries is an inadequately explored subject. While historically accounting for 2 to 5% of combat-related injuries, GU-related injuries escalated considerably during U.S. involvements in Iraq and Afghanistan due to improvised explosive devices (IEDs). Advanced body armor increased survivability while altering injury patterns, with a shift toward bladder and external genitalia injuries. Forward-deployed surgeons and military medics manage treatment, with Role 2 facilities addressing damage control resuscitation and surgery, including GU-specific procedures. The review aims to provide an overview of GU trauma and enhance medical readiness for battlefield scenarios.
This review examined urologic trauma management in combat, searching PubMed, Cochrane Central, Scopus, and Web of Science databases with search terms "wounds" OR "injuries" OR "hemorrhage" AND "trauma" AND "penile" OR "genital" AND "combat." Records were then screened for inclusion of combat-related urologic trauma in conflicts after 2001 and which were English-based publications. No limits based on year of publication, study design, or additional patient-specific demographics were implemented in this review.
Ultimately, 33 articles that met the inclusion criteria were included. Included texts were narrowed to focus on the management of renal injuries, ureteral trauma, bladder injuries, penile amputations, urethral injuries, testicular trauma, Central nervous system (CNS) injuries, and female GU injuries.
In modern conflicts, treatment of GU trauma at the point of injury should be secondary to Advanced Trauma Life Support (ATLS) care in addition to competing non-medical priorities. This review highlights the increasing severity of GU trauma due to explosive use, especially dismounted IEDs. Concealed morbidity and fertility issues underscore the importance of protection measures. Military medics play a crucial role in evaluating and managing GU injuries. Adherence to tactical guidelines and trained personnel is vital for effective management, and GU trauma's integration into broader polytrauma care is essential. Adequate preparation should address challenges for deploying health care providers, prioritizing lifesaving and quality-of-life care for casualties affected by GU injuries.
战斗导致的泌尿生殖系统（GU）创伤及其治疗是一个尚未得到充分研究的课题。虽然历史上泌尿生殖系统相关损伤占战斗相关损伤的2%至5%，但在美国参与伊拉克和阿富汗战争期间，由于简易爆炸装置（IED），此类损伤大幅增加。先进的防弹衣提高了生存率，同时改变了损伤模式，导致膀胱和外生殖器损伤增多。前沿部署的外科医生和军事医护人员负责治疗，二级医疗设施负责损害控制复苏和手术，包括特定于泌尿生殖系统的手术。本综述旨在概述泌尿生殖系统创伤，并提高应对战场情况的医疗准备水平。
本综述研究了战斗中泌尿生殖系统创伤的管理，在PubMed、Cochrane Central、Scopus和科学网数据库中搜索，搜索词为“伤口”或“损伤”或“出血”以及“创伤”以及“阴茎”或“生殖器”以及“战斗”。然后筛选记录，以纳入2001年后冲突中与战斗相关的泌尿生殖系统创伤且为英文出版物。本综述未对出版年份、研究设计或其他患者特定人口统计学特征设置限制。
最终，纳入了33篇符合纳入标准的文章。纳入的文本聚焦于肾损伤、输尿管创伤、膀胱损伤、阴茎离断、尿道损伤、睾丸创伤、中枢神经系统（CNS）损伤和女性泌尿生殖系统损伤的管理。
在现代冲突中，除了应对其他非医疗优先事项外，在受伤现场对泌尿生殖系统创伤的治疗应次于高级创伤生命支持（ATLS）护理。本综述强调了由于使用爆炸物，尤其是徒步简易爆炸装置导致的泌尿生殖系统创伤日益严重。潜在的发病率和生育问题凸显了保护措施的重要性。军事医护人员在评估和管理泌尿生殖系统损伤方面发挥着关键作用。遵守战术指南和训练有素的人员对于有效管理至关重要，并且将泌尿生殖系统创伤纳入更广泛的多发伤护理中至关重要。充分的准备应应对部署医疗保健人员的挑战，优先为受泌尿生殖系统损伤影响的伤员提供救生和生活质量护理。
