Operative Management of Wartime Genitourinary Injuries at Balad Air Force Theater Hospital, 2005 to 2008

Purpose: We detail the 3-year experience of operative combat urology of genitourinary surgeons stationed at Balad Air Force Theater Hospital, Balad, Iraq. Materials and Methods: We performed an institutional review board approved, retrospective review of operative logs of the 9 urologists deployed to Balad Air Force Theater Hospital from June, 1 2005 to June 1, 2008. All operative cases performed by the urologists deployed to this facility were reviewed. Patients were grouped by injury location and operative approach. Analysis included the calculation of relative injury rates by location and the incidence of organ preservation. Results: During the 36 months reviewed 273 patients underwent a total of 361 operative and 25 endoscopic procedures for 1 or more genitourinary injuries. Of the patients 227 (83.1%) had wounds to the lower genitourinary tract, 39 (14.3%) had wounds to the upper genitourinary tract and 7 (2.6%) had upper and lower genitourinary injuries. Exploration, débridement and repair of soft tissue injury to the external genitalia were the most commonly performed procedures. Of the 88 testicular injuries explored testicular salvage was achieved in 45 (51.1%). Nephrectomy was required in 17 of the 27 operative renal injury cases (63.0%). Conclusions: Most genitourinary injuries treated at Balad Air Force Theater Hospital involve the lower genitourinary tract. The high frequency of genital trauma often requires staged reconstructive procedures. Acceptable renal and testicular salvage rates are attainable. This study highlights the diverse array of surgical treatment modalities needed to manage genitourinary trauma during Operation Iraqi Freedom.