Genitourinary Injuries

An unprecedented number of US service members sustained genitourinary (GU) injuries during the recent wars in Iraq and Afghanistan. The majority of GU injuries were sustained by men and caused by blast mechanisms. Injuries to the external genitalia predominated and were commonly one component of multisystem trauma, often including extremity amputation(s), pelvic fracture, and colorectal injuries. Internal GU injuries (kidney, ureter, bladder) were less common, likely due to the ubiquitous utilization of body armor by US personnel. The initial management of GU injuries should follow damage control philosophy, while ensuring adequate urinary drainage, genital tissue preservation, and subspecialist care. Long-term management should focus on the restoration of urinary, sexual, and reproductive function, each of which can be challenged by the abundant complicating factors associated with polytrauma. However, with appropriate multidisciplinary care, restoration of GU function after blast injury is possible in the majority of patients.