title: Genitourinary injuries and extremity amputation in Operations Enduring Freedom and Iraqi Freedom: Early findings from the Trauma Outcomes and Urogenital Health (TOUGH) project.
abstract: BACKGROUND
  In Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF), genitourinary (GU) wounds have occurred in unprecedented numbers. Severe concomitant injuries, including extremity amputations, are common. The epidemiology of GU injury and extremity amputation in OEF/OIF has not been described.
  
  
  METHODS
  The Department of Defense Trauma Registry was queried from October 2001 through August 2013 to identify all surviving US male service members with GU injuries sustained in OEF/OIF. Genitourinary injury was defined as sustaining one or more injuries to any organ or structure within the genitourinary and/or reproductive system(s) based on International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Injury severity was quantified based on Abbreviated Injury Scale scores and overall Injury Severity Scores. The incidence, nature, and severity of GU injuries and extremity amputations are described.
  
  
  RESULTS
  Of the 1,367 service members with GU injury included in this analysis, 433 (31.7%) had one or more extremity amputations. Most GU injuries were to the external genitalia [scrotum (55.6%), testes (33.0%), penis (31.0%), and urethra (9.1%)] vs. the kidneys (21.1%). Those with amputation(s) had greater GU injury severity (Abbreviated Injury Scale score ≥ 3) than those without amputations (50.1% vs. 30.5%, respectively; p < 0.0001). Approximately 3.4% of male service members with GU injury had an upper extremity amputation only, 8.9% had both lower and upper extremity amputation(s), and 19.4% had lower extremity amputation(s) only. Of the 387 patients with GU injury and lower extremity amputations, 87 (22.5%) had amputations below the knee and 300 (77.5%) had amputation(s) at/above the knee.
  
  
  CONCLUSIONS
  In OEF/OIF, concomitant GU injury and extremity amputation are common and have serious implications for health and quality of life. This wounding pattern presents new challenges to the military medical and research and development communities to prevent, mitigate, and treat these battlefield injuries.
  
  
  METHODS
  Epidemiologic/prognostic study, level III.
authors: From the US Army Institute of Surgical Research (N.S.N., J.C.J., J.C.R.), JBSA Fort Sam Houston, Texas; Urology Service, Department of Surgery (S.J.H.), and Department of Orthopaedics (J.C.R.), San Antonio Military Medical Center, JBSA Fort Sam Houston, Texas; Technology Office (E.A.L.), Defence Equipment and Support, Ministry of Defence, Bristol, United Kingdom; Surgical Services (D.W.S.), San Antonio Military Medical Center, JBSA Fort Sam Houston, Texas; Joint Trauma System (J.A.O.), US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas; Department of Epidemiology and Biostatistics (J.A.O.), University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors: Nina S
authors: NS
authors: Nnamani
authors: Judson C
authors: JC
authors: Janak
authors: Steven J
authors: SJ
authors: Hudak
authors: Jessica C
authors: JC
authors: Rivera
authors: Eluned A
authors: EA
authors: Lewis
authors: Douglas W
authors: DW
authors: Soderdahl
authors: Jean A
authors: JA
authors: Orman
mesh_terms: D015998:Abbreviated Injury Scale; D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D000671:Amputation, Surgical; D005121:Extremities / Q000293:injuries* / Q000601:surgery; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008889:Military Personnel; D009104:Multiple Trauma / Q000453:epidemiology; D014481:United States; D014566:Urogenital System / Q000293:injuries*; D055815:Young Adult