No abstract

This report details the incidence and description of trauma to the external genitalia experienced during Operation Iraqi Freedom at a United States Army Combat Support Hospital, and demonstrates that acceptable rates of testicular salvage are possible in the combat setting. The operating room logs and the Joint Theater Trauma Registry were used to conduct a retrospective review of the patients who sustained genitourinary (GU) injuries at an US Army Combat Support Hospital (CSH) in Iraq from 27 February 2007 to 14 August 2007. Of the 3595 battle trauma injuries seen at the CSH during the time period, 168 (4.7%) had one or more GU injuries for a total of 172 GU injuries. Of these patients, 115 (68%) with GU injuries had one or more injuries to the external genitalia for a total of 119 external GU injuries. Penetrating trauma to the penis and scrotum accounted for 59 of the injuries. In total, 43 testicles were injured in 34 patients (9 had bilateral injuries). In total, 32 testes were repaired primarily and 11 were removed. Injuries to the external genitalia continue to account for the vast majority of GU trauma in a combat setting. Of patients who presented with penetrating testicular trauma, there was a 74.4% salvage rate, which is higher than previous reports of combat external genitalia injuries. Treatment of penetrating trauma to the external genitalia in a combat setting requires attention to tissue preservation while coordinating associated surgical procedures.

Robot-assisted laparoscopic prostatectomy is rapidly gaining favor as a minimally invasive method to surgically address prostate cancer. The sophisticated equipment and unique positioning requirements of this technology require exceptional preparation and attention to detail to minimize the chance of surgical complications. We present the case of a 57-year-old man who developed left calf compartment syndrome after (robot-assisted laparoscopic prostatectomy) requiring fasciotomies. We use this example to highlight specific areas of risk unique to the da Vinci Surgical System® using intraoperative photos to show danger areas as well as review basic positioning requirements common to all prolonged pelvic surgeries performed in Trendelenburg position.

Men's health issues have increasingly gained attention not only in the mass media, but also among most health-care providers. The diagnosis and treatment of male-related health problems, unfortunately, can lead to complications and error-related injuries resulting in claims of medical malpractice. This review article will look at the most common claims relating to complications and injuries in the management of men's health issues. Reviews of the literature over the past three decades using multiple search engines including PubMed were utilized. The most pertinent articles were selected on the basis of their relevance to men's health issues, complications and medico-legal ramifications. An evaluation of the literature reveals that although the number of claims against urologists has not increased over the past several decades, indemnity payments have continued to rise significantly. Claims can be divided into those relating to diagnosis and those relating to treatment. Providers of men's health care may become involved in claims of medical malpractice at some time during their careers. Patients' care can result in complications and injuries, most of which do not lead to claims. Certain areas of men's health lead to more claims than others. The keys to prevention and management of those claims are good communication, informed consent and documentation.