Genito-Urinary Trauma in the War Context: A Review of Two Decades of Experience From the French Armed Forces.

Abstract

Background: In recent conflicts, injuries to urogenital organs ranged from 5 to 7.2% of all combat-related injuries. Open surgery remains the main approach in combat settings, and in the French military, urgent surgical procedures are mostly performed by general surgeons with no specialization in urological care. To explore the specific needs in advanced surgery courses, we aimed to describe the epidemiology and management of genito-urinary traumas in recent conflicts in French Medical Treatment Facilities (MTFs).

Methods: Data were extracted from the OPEX® registry, which prospectively recorded surgical activity from 2001 to 2021. All patients treated in French Role 2 Enhanced or 3 MTFs requiring emergency surgery for urogenital injury were included. The mechanism of trauma, type of genito-urinary injury (GUI), and surgical management were reported.

Results: After screening, a total of 4,603 patients were admitted for emergency or delayed emergency surgery. Among them, 31 (0.67%) patients had urogenital injuries requiring immediate management. Most injuries were combat-related (77.4%), caused by gunshots (45%) and explosions (29%). Ten patients (32%) were hemodynamically unstable at initial management. Bladder and testicular injuries were the most common (12 [39%] and 8 [25.8%], respectively). Kidney injuries were rare but led to organ extirpation in 60% of the cases. Associated digestive injuries occurred in 45.2% of the cases. All procedures used the open approach.

Conclusion: This study is the first to examine genito-urinary traumas in overseas operations during French army deployments. The results highlight the relatively low incidence of urological trauma, with most injuries involving the bladder and testis. Our findings highlight the importance of equipping military surgeons with the skills necessary to manage complex cases.