Mahmud Husny, Mor Yoram, Givon Adi, Kitrey Noam
Department of Urology, The Chaim Sheba Medical Center, Hashomer, 52621, Ramat Gan, Israel.
Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
World J Urol. 2025 Sep 2;43(1):528. doi: 10.1007/s00345-025-05899-5.
Urological trauma significantly affects patient morbidity, functional outcomes, and healthcare resource utilization. This study evaluated war-related genitourinary (GU) injuries that occurred during the Israeli-Gaza War, with a focus on injury patterns, management, and clinical outcomes.
We conducted a retrospective analysis utilizing the Israeli National Trauma Registry, which is managed by the Gertner Institute for Health Policy and Epidemiology. This registry captures data on all of the patients admitted to trauma centers in Israel. Data quality is maintained through ongoing training of data abstractors and regular audits of registry data. All documented hospitalizations from October 7, 2023, to May 31, 2024, were included, excluding noncombat-related injuries. GU injuries were classified by anatomical location into the upper urinary tract (kidney/ureter), lower urinary tract (bladder/urethra), and external genitalia (penis/scrotum/testes). The data collected included demographics, injury mechanisms, injury severity score (ISS), surgical management, and clinical outcomes (ICU admissions, hospital length of stay [LOS], rehabilitation needs, and mortality). GU patients were compared with non-GU patients.
Of the 2,422 total casualties, 117 (4.8%) sustained GU injuries. The mean age was 27.2 ± 9.2 years (range 14-76) in the GU-injured casualty group versus 30.1 ± 15.1 years (range 0-97) in the non-GU casualty group; the difference was not significant (p = 0.43), with 97.4% males. Explosive devices (59.0%) and gunshot wounds (36.8%) were the predominant injury mechanisms. Severe injuries (ISS ≥ 16) occurred significantly more frequently among GU-injured patients (61.5% vs. 21.6%, p < 0.0001). External genital injuries were the most common injuries (60.7%), followed by kidney (27.4%) and bladder damage (10.3%). Associated pelvic fractures occurred in 18% of the GU trauma patients versus 1.8% of the non-GU-injured patients (p < 0.0001). Surgical interventions were performed in 84.6% of the patients, among whom scrotal/testicular surgeries (27.4%) were most common. ICU admissions (44.4%), prolonged hospitalizations ≥ 14 days (41.4%), rehabilitation needs (53.0%), and mortality (6.8%) were significantly greater among GU-injured patients.
War-related GU trauma, although relatively uncommon, involves severe injuries, extensive surgical management, prolonged hospitalizations, and substantial rehabilitation demands. Enhancements in protective equipment and multidisciplinary treatment strategies are critical for optimizing outcomes in future conflicts.
泌尿外科创伤会显著影响患者的发病率、功能结局以及医疗资源的利用。本研究评估了以色列-加沙战争期间发生的与战争相关的泌尿生殖系统（GU）损伤，重点关注损伤模式、治疗方法及临床结局。
我们利用由格特纳健康政策与流行病学研究所管理的以色列国家创伤登记处进行了一项回顾性分析。该登记处收集了所有入住以色列创伤中心患者的数据。通过对数据录入人员的持续培训以及对登记数据的定期审核来确保数据质量。纳入了2023年10月7日至2024年5月31日期间所有有记录的住院病例，但不包括与战斗无关的损伤。GU损伤按解剖位置分为上尿路（肾脏/输尿管）、下尿路（膀胱/尿道）和外生殖器（阴茎/阴囊/睾丸）。收集的数据包括人口统计学信息、损伤机制、损伤严重程度评分（ISS）、手术治疗情况以及临床结局（入住重症监护病房、住院时间[LOS]、康复需求和死亡率）。将GU损伤患者与非GU损伤患者进行比较。
在2422名总伤亡人员中，117人（4.8%）遭受了GU损伤。GU损伤伤亡组的平均年龄为27.2±9.2岁（范围14 - 76岁），而非GU伤亡组为30.1±15.1岁（范围0 - 97岁）；差异无统计学意义（p = 0.43），男性占97.4%。爆炸装置（59.0%）和枪伤（36.8%）是主要的损伤机制。GU损伤患者中重伤（ISS≥16）的发生率显著更高（61.5%对21.6%，p < 0.0001）。外生殖器损伤是最常见的损伤（60.7%），其次是肾脏损伤（27.4%）和膀胱损伤（10.3%）。18%的GU创伤患者发生了相关骨盆骨折，而非GU损伤患者中这一比例为1.8%（p < 0.0001）。84.6%的患者接受了手术干预，其中阴囊/睾丸手术（27.4%）最为常见。GU损伤患者的重症监护病房入住率（44.4%）、住院时间延长≥14天（41.4%）、康复需求（53.0%）和死亡率（6.8%）均显著更高。
与战争相关的GU创伤虽然相对不常见，但涉及重伤、广泛的手术治疗、长时间住院以及大量的康复需求。改进防护装备和多学科治疗策略对于优化未来冲突中的结局至关重要。
