Management of combat-related urological trauma in the modern era

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.