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T Injury to the pelvic region always


has been a hazard of war. During World War II, the Korean War, and the Viet- nam War, genitourinary trauma most often resulted from small-arms fire and shrapnel from mortars, military ana- lysts report. Today, the greatest threat is improvised explosive devices, which send a blast upward through the legs and into the groin. Between 2001 and 2013, more than


1,300 servicemembers have come home with significant genitourinary trauma, according to Jean A. Orman, Sc.D., chief of Statistics and Epide- miology at the U.S. Army Institute of Surgical Research. In most cases, damage to the pelvic


region was extensive and included injury to or loss of the penis, injury to or loss of the testicles, and significant damage to the surrounding pelvic tis- sue resulting from the explosive blast driving dirt and debris upward into the body. The majority of patients also experienced other injuries, in- cluding blunt force trauma, amputa- tion of limbs, lacerations, and burns. As a result, associated PTS and TBI have been common comorbidities among servicemembers with these types of injuries. Dr. W.P. Andrew Lee, chair of the Department of Plastic and Reconstruc- tive Surgery at the Johns Hopkins University School of Medicine in Bal-


66 MILITARY OFFICER AUGUST 2016


THE WARS IN AFGHANISTAN AND IRAQ HAVE PRODUCED SEVERAL SIGNATURE WOUNDS, including post-traumatic stress (PTS), traumatic brain injury (TBI), and traumatic ampu- tation. Less discussed, but just as devastating, is genitourinary trauma, a health issue that, like the others, has far-reaching con- sequences for patients and their families.


timore, is among those who attribute the increase in reported genitourinary injuries to the use of body armor and greatly improved field medicine, both of which help save lives that would have been lost in earlier conflicts. Un- fortunately, the body armor worn by most servicemembers today protects the upper torso but leaves the groin area exposed to an upward blast. Many servicemembers in combat


zones fear incurring genitourinary in- juries, and military doctors say it’s not uncommon for wounded warriors to ask about their genitals immediately upon waking up in the hospital. This is understandable given the majority of fighters in today’s military are young men who have been indoctrinated into a unique culture of masculinity, are sexually active, and also might hope to father children someday. The sudden loss of their sexuality and sexual function, psychologists say, is understandably shattering. Indeed, genitourinary trauma can


have a devastating effect on a ser- vicemember’s quality of life, warned experts at Artiss Symposium 2012: Evaluation and Treatment of Genital Injuries in Combat Warriors, spon- sored by the departments of Psychiatry and Urology at Walter Reed National Military Medical Center in Bethesda, Md., and the Center for the Study of Traumatic Stress, Department of Psy-


chiatry at the Uniformed Services Uni- versity, also in Bethesda. Depending on the severity of the injury, associated problems might include significant scarring, disfigurement, loss of sexual function, and infertility. It’s no wonder, then, that men so afflicted become depressed and express concern their significant others will abandon them. Unfortunately, depression sometimes exacerbates their sexual dysfunction, doctors say. However, all is not lost: Plastic


surgeons have developed procedures to treat many types of genitourinary injuries. If the genitals are not too badly damaged, medication may help restore sexual function. For more severe injuries or the complete loss of genitalia, the patient’s own tissue can sometimes be used to construct a penis. Though it cannot be used for sexual activity, the new organ usually allows for normal urination. A new scrotum similarly can be constructed, with prosthetic testicles implanted to give it a natural appearance. Such has been the gold standard


of treatment for many years. But re- cently, specialists with the Johns Hop- kins University School of Medicine announced a new possibility: penile transplants using donor organs. Other medical centers, including Massachu- setts General Hospital and the Wake Forest Institute for Regenerative Med-


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