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Kronstedt S, Wahlstedt E, Blacker M, Saffati G, Hinojosa-Gonzalez DE, Wilbert H, Fetherston T, Friedman J, Mucher ZR. Urologic Trauma Management for Military Providers. Mil Med 2024:usae341. [PMID: 39028177 DOI: 10.1093/milmed/usae341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/09/2024] [Accepted: 06/24/2024] [Indexed: 07/20/2024] Open
Abstract
INTRODUCTION 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. MATERIALS AND METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Shane Kronstedt
- Department of Urology, Baylor College of Medicine, Houston, TX 77030-3411, USA
| | - Eric Wahlstedt
- University of Kentucky School of Medicine, Lexington, KY 40506-0107, USA
| | - Mason Blacker
- NYU Grossman School of Medicine, New York, NY 10016-6402, USA
| | - Gal Saffati
- Department of Urology, Baylor College of Medicine, Houston, TX 77030-3411, USA
| | | | - Hance Wilbert
- Saint Louis University School of Medicine, Saint Louis, MO 63147-2912, USA
| | | | | | - Zachary R Mucher
- Houston Methodist Urology Associates, Houston, TX 77094-1521, USA
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MacGregor AJ, Dougherty AL, Crouch DJ, Dye JL. Sex Differences in Screening Positive for Post-Traumatic Stress Disorder After Combat Injury. Mil Med 2024:usae050. [PMID: 38771005 DOI: 10.1093/milmed/usae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/08/2023] [Accepted: 02/21/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION U.S. military women were at risk of combat exposure and injury from asymmetric warfare during the conflicts in Iraq and Afghanistan. Previous research has yielded mixed results when examining sex differences in PTSD following operational deployment. To date, no study has explored sex differences in PTSD after combat injury. MATERIALS AND METHODS This retrospective study included U.S. military service men and women who experienced a combat injury in Iraq or Afghanistan (March 2003 to March 2013) and completed a Post-Deployment Health Assessment (PDHA) within 1 year of injury. The PDHA is administered at the end of deployment and includes the 4-item Primary Care PTSD Screen. The prevalence of screening positive for PTSD was evaluated by sex using a chi-square test. Multivariable logistic regression was used to assess the association between sex and PTSD while adjusting for covariates. RESULTS The study sample included 16,215 injured military personnel (666 women and 15,549 men). The average time between injury and PDHA was 132 days (SD = 91.0). Overall, women had a higher prevalence of screening positive for PTSD than men (48.3% vs. 40.9%, P < .001). In multivariable regression, women had higher odds than men of screening positive for PTSD (odds ratio, 1.34; 95% confidence interval, 1.14-1.57). Psychiatric history was the strongest predictor of screening positive for PTSD regardless of sex (odds ratio, 1.59; 95% confidence interval, 1.45-1.74). CONCLUSIONS In this novel study of military service members, women were more likely to screen positive for PTSD than men after combat injury. Strategies to mitigate PTSD, enhance resiliency, and incorporate psychological care into injury rehabilitation programs for women may be needed for future U.S. military conflicts where they will play a larger role in combat operations.
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Affiliation(s)
- Andrew J MacGregor
- Epidemiology and Data Management Support, Naval Health Research Center, San Diego, CA 92106, USA
| | - Amber L Dougherty
- Epidemiology and Data Management Support, Naval Health Research Center, San Diego, CA 92106, USA
- Leidos, Inc., San Diego, CA 92106, USA
| | - Daniel J Crouch
- Epidemiology and Data Management Support, Naval Health Research Center, San Diego, CA 92106, USA
| | - Judy L Dye
- Epidemiology and Data Management Support, Naval Health Research Center, San Diego, CA 92106, USA
- Leidos, Inc., San Diego, CA 92106, USA
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Dell'Aversana F, Comune R, Scognamiglio M, Grassi F, Durante A, Avallone R, Tonerini M, Affinito P, Tamburro F, Scaglione M. Gunshot vaginal trauma. Radiol Case Rep 2023; 18:4544-4548. [PMID: 37868007 PMCID: PMC10587674 DOI: 10.1016/j.radcr.2023.09.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/17/2023] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
Nonobstetric vaginal or vulva trauma is an extremely rare occurrence, with an incidence of < 0.2% of traumas. CT represents the gold standard in the diagnosis of gunshot lesions due to its ability to detect and stage injuries with very high sensitivity and specificity. A standardized protocol for penetrating trauma is still under debate for the use of intravenous contrast only or also rectal and oral contrast. Herein, we report a case of gunshot vaginal trauma in a 43-year-old patient presenting with vaginal bleeding. In our case, the protocol was "patient's tailored," the intravaginal selective use of air was administered due to symptoms (vaginal bleeding) and CT findings, this 2-step protocol increased diagnostic confidence and allow a correct and challenging diagnosis.
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Affiliation(s)
- Federica Dell'Aversana
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Rosita Comune
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Marco Scognamiglio
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Francesca Grassi
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Adele Durante
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Roberta Avallone
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Michele Tonerini
- Department of Emergency Radiology, Cisanello Hospital, Pisa, Italy
| | - Pietro Affinito
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Fabio Tamburro
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Naples, Italy
| | - Mariano Scaglione
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Piazza Università, Sassari, Italy
- Department of Radiology, James Cook University Hospital, Middlesbrough, UK
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McDonald J, Liang SY, Li P, Stewart L, Tribble DR. DoD-VA Trauma Infection Research Collaboration. Mil Med 2022; 187:17-24. [PMID: 35512378 DOI: 10.1093/milmed/usab482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/28/2021] [Accepted: 11/05/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In the aftermath of wars, there is a surge in the number of wounded service members who leave active duty and become eligible for healthcare through the Department of Veterans Affairs (VA). Collaborations between the Department of Defense (DoD) and VA are crucial to capture comprehensive data and further understand the long-term impact of battlefield trauma. We provide a summary of the development, methodology, and status of an effective collaboration between the Infectious Disease Clinical Research Program and the St. Louis VA Health Care System with the multicenter, observational Trauma Infectious Disease Outcomes Study (TIDOS), which examines the short- and long-term outcomes of deployment-related trauma. METHODS As part of TIDOS, wounded service members who transitioned to participating military hospitals in the United States (2009-2014) were given the opportunity to enroll in a prospective follow-up cohort study to continue to capture infection-related data after their hospital discharge. Enrollees in the TIDOS cohort who left military service and received health care through the VA also had the option of consenting to have relevant VA medical records abstracted and included with the study data. Infections considered to be complications resulting from the initial trauma were examined. RESULTS Among 1,336 TIDOS enrollees, 1,221 (91%) registered and received health care through the VA with 633 (47%) consenting to follow-up using VA records and comprising the TIDOS-VA cohort. Of the first 337 TIDOS-VA cohort enrollees, 38% were diagnosed with a new trauma-related infection following hospital discharge (median: 88 days; interquartile range: 18-351 days). Approximately 71% of the infections were identified through DoD sources (medical records and follow-up) and 29% were identified through VA electronic medical records, demonstrating the utility of DoD-VA collaborations. The TIDOS DoD-VA collaboration has also been utilized to assess intermediate and long-term consequences of specific injury patterns. Among 89 TIDOS-VA cohort enrollees with genitourinary trauma, 36% reported sexual dysfunction, 21% developed at least one urinary tract infection, 14% had urinary retention/incontinence, and 8% had urethral stricture. The rate of urinary tract infections was 0.05/patient-year during DoD follow-up time and 0.07/patient-year during VA follow-up time. CONCLUSIONS Wider capture of infection-related outcome data through the DoD-VA collaboration provided a clearer picture of the long-term infection burden resulting from deployment-related trauma. Planned analyses include assessment of osteomyelitis among combat casualties with amputations and/or open fractures, evaluation of mental health and social factors related to injury patterns, and examination of health care utilization and cost in relation to infectious disease burdens.
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Affiliation(s)
- Jay McDonald
- Infectious Diseases Section, Veterans Affairs St. Louis Health Care System, St. Louis, MO 63106, USA.,Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Stephen Y Liang
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Ping Li
- Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Laveta Stewart
- Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - David R Tribble
- Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Adeleye AJ, Kristof TW, Naik AG, Madueke Laveaux S, Cone J, Faris S, Zakrison TL. Hidden trauma: shedding light on the relationship between gun violence and infertility. F S Rep 2021; 3:66-79. [PMID: 35937444 PMCID: PMC9349231 DOI: 10.1016/j.xfre.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/20/2021] [Accepted: 11/23/2021] [Indexed: 11/28/2022] Open
Abstract
Objective To study the existing data on the relationship between penetrating abdominopelvic injuries and fertility guidance on managing fertility concerns of these patients using a case report and scoping review. Design Case report and scoping review. Setting Not applicable. Patient(s) People who have experienced abdominopelvic trauma from gun violence or in the course of combat. Intervention(s) None. Main Outcome Measure(s) We extracted case report data from electronic health records. We performed a scoping review using PubMed and Scopus. Search terms were related to penetrating abdominopelvic trauma, gunshot wounds (GSW), war, and fertility/infertility. We evaluated the study year, age and race, mechanism of injury, fertility outcomes, and how fertility concerns were addressed with patients who experienced penetrating abdominopelvic trauma. Result(s) In the case report, the couple had 10 years of infertility. The male partner experienced an abdominopelvic GSW before attempting to conceive. After evaluation, he was diagnosed with retrograde ejaculation. He recalled being advised that his GSW might affect his future fertility. The couple has discontinued care. For the scoping review, 879 sources were identified and 25 studies were included in the review. Among the studies conducted in the United States, most patients included were African American. Eighty-eight percent (n = 22) of the sources acknowledged the importance of fertility or used fertility-related outcome measures. One study commented on how to address fertility concerns with victims of abdominopelvic penetrating trauma. Conclusion(s) There is a paucity of data on the intersection of penetrating abdominopelvic injuries and fertility or guidance on how to discuss fertility issues with patients.
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Affiliation(s)
- Amanda J. Adeleye
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, the University of Chicago, Chicago, Illinois
- Reprint requests: Amanda J. Adeleye, M.D., Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, the University of Chicago, 5841 South Maryland Avenue, MC 2050, Chicago, Illinois 60637.
| | | | - Aaditi G. Naik
- the Biological Sciences Division, the University of Chicago, Chicago, Illinois
| | - Sandra Madueke Laveaux
- the Section of Minimally Invasive Gynecologic Surgery, the Department of Obstetrics and Gynecology, the University of Chicago Medicine & Biological Sciences, Chicago, Illinois
| | - Jennifer Cone
- the Department of Surgery, the University of Chicago Medicine & Biological Sciences, Chicago, Illinois
| | - Sarah Faris
- University of Chicago Medical Center, Chicago, Illinois
| | - Tanya L. Zakrison
- Section of Trauma Surgery Department of Surgery, the University of Chicago Medicine & Biological Sciences, Chicago, Illinois
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MacGregor AJ, Zouris JM, Dougherty AL, Dye JL. Health Profiles of Military Women and the Impact of Combat-Related Injury. Womens Health Issues 2021; 31:392-398. [PMID: 34059434 DOI: 10.1016/j.whi.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 03/26/2021] [Accepted: 03/31/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE The role of women in the United States military is expanding. Women are now authorized to serve in all military occupations, including special operations and frontline combat units, which places them at increased risk of combat exposure and injury. Little is known regarding the impact of these injuries on the health of military women. METHODS We conducted a retrospective matched cohort study of women service members who were injured during combat operations in Iraq and Afghanistan. Injured women were individually matched to non-injured controls at a 1:4 ratio. Medical diagnostic codes were abstracted from outpatient encounters in electronic health records, and hierarchical clustering was conducted to identify clusters of diagnostic codes, termed "health profiles." Conditional logistic regression was used to determine whether combat-related injury predicted membership in the profiles. RESULTS The study sample included 590 injured women and 2360 non-injured controls. Cluster analysis identified six post-deployment health profiles: low morbidity, anxiety/headache, joint disorders, mixed musculoskeletal, pregnancy-related, and multimorbidity. Combat-related injury predicted membership in the anxiety/headache (odds ratio, 1.73; 95% confidence interval, 1.38-2.16) and multimorbidity (odds ratio, 3.43; 95% confidence interval, 2.65-4.43) profiles. CONCLUSIONS Combat-related injury is associated with adverse post-deployment health profiles among military women, and women with these profiles may experience increased health care burden. As future conflicts will likely see a greater number of women with combat exposure and injury, health outcomes research among military women is paramount for the purposes of medical planning and resource allocation.
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Affiliation(s)
- Andrew J MacGregor
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California.
| | - James M Zouris
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California
| | - Amber L Dougherty
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California; Leidos, Inc., San Diego, California
| | - Judy L Dye
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California; Leidos, Inc., San Diego, California
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Wang XR, Black KA, Rich R. Retained Shotgun Pellets in the Vulva: Case Report. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:763-765. [PMID: 33166676 DOI: 10.1016/j.jogc.2020.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Vulvar trauma is relatively uncommon and typically occurs in accidental or sports-related injuries. There is limited literature for management of penetrating trauma to the vulva. CASE A 38-year-old G9, P9 woman presented to the gynaecology service for assessment of vulvar injury after a gunshot wound to the right lateral thigh. She underwent initial stabilization and operative management by the Trauma and Plastic Surgery services for predominantly soft-tissue injuries. Multiple gunshot pellets were found embedded in the right labia majora and medial thigh. On assessment, surgical removal was deemed necessary on the basis of symptoms and potential for functional impairment. CONCLUSION We present the first reported case on the management of vulvar injury secondary to penetrating trauma. The principles of non-obstetrical vulvar trauma management are discussed.
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Affiliation(s)
- Xinjue Rachel Wang
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB.
| | - Kristin A Black
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB
| | - Rebecca Rich
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB
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Nnamani NS, Pugh MJ, Amuan ME, Eapen BC, Hudak SJ, Liss MA, Orman JA. Outcomes of Genitourinary Injury in U.S. Iraq and Afghanistan War Veterans Receiving Care from the Veterans Health Administration. Mil Med 2018; 184:e297-e301. [DOI: 10.1093/milmed/usy196] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/12/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Nina S Nnamani
- US Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX
| | - Mary Jo Pugh
- Department of Epidemiology and Biostatistics, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX
- South Texas Veterans Health Care System, 7400 Merton Minter St., San Antonio, TX
| | - Megan E Amuan
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, 200 Springs Road, Bedford, MA
| | - Blessen C Eapen
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, 7400 Merton Minter St., San Antonio, TX
- Department of Rehabilitation Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive San Antonio, TX
| | - Steven J Hudak
- Urology Clinic, Department of Surgery, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX
- Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
| | - Michael A Liss
- South Texas Veterans Health Care System, 7400 Merton Minter St., San Antonio, TX
- Department of Urology, University of Texas Health San Antonio, 7703 Floyd Curl Drive San Antonio, TX
| | - Jean A Orman
- Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
- Joint Trauma System, 3698 Chambers Pass, JBSA Fort Sam Houston, San Antonio, TX
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