Urogenital wounds during the war in Croatia in 1991/1992

There were 142 war injuries to the urogenital organs in 115 of 4,425 wounded patients treated at our clinical hospital during 18 months of warfare in Osijek, Croatia. Kidney injury was the most common (64 cases) and urethral injury (4) the least common, with a relatively large number of ureteral injuries (11). Two-thirds of the injuries were associated with other trauma, most frequently abdominal injuries. The mortality rate was high (15.6%), explained by the proximity of the battlefield and resulting rapid patient transport (average 52.21 minutes), which excluded the possibility of separating out the moribund cases, as well as the exceptional destructive power of modern explosives and firearms, and associated wounds of the vital organs. Of the wounded 60% were members of the Croatian armed forces, 1 was a member of the United Nations Professional Force and 39.13% were civilians. Surgical intervention was characterized by a tendency toward conservation and the avoidance of organ sacrifice. Thus, nephrectomy was performed in only a quarter of the cases of renal injury. Nevertheless, orchiectomy was performed in two-thirds of the cases of testicular injury. In 5 of 8 cases of corpus spongiosum injury the tunica albuginea was primarily reconstructed with free transplantation of the fascia lata. For ureteral injury resection with primary suture yielded good results in contrast to stents without resection in cases of ureteral wall contusion, which resulted in ureteral stenosis in our patients.