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Abstract

This study aims to compare the urologic injuries treated at Kuwait during the Gulf War with those recently reported by the United States urologic surgeons. Gunshot caused the majority of the injuries (58%) on our side of the battle compared with fragmentation injuries (83%) on the other side. We had statistically significant higher renal and ureteric injuries (14/35 compared with 5/30; p<0.04, Chi-square). This difference can be explained by the use of the flak jackets on the other side or the difference of the type of weapons used. Our management had a similar preservative approach. Only 4/12 of renal injuries (33%) had nephrectomy. Two ureteric injuries were missed by general surgeons which were successfully managed by the urologists. This study supports the presence of urologists within military surgical teams.

The Incidence, Management, and Outcome of Penetrating Bladder Injuries in Civilians Resultant from Armed Conflict in Baghdad 2005-2006

“…In general, they were successfully managed, as no significant increase in mortality was found. In this study and others, small and large bowels were also commonly injured, with rates reaching 34% and 33% for small and large bowels, respectively [6, 8, 9]. Urethral injury was found in 3% of the cases.…”

“…We had ureteric involvement in 4 (6%) cases, while it is usually found in 4%–6% of all urological injuries [9]. Three of our cases were discovered during surgery and treated with immediate reimplantation, while the fourth one was missed, and reimplantation was done successfully later.…”

“…In Vietnam and Croatia, bladder injuries occurred in 15% of those with GU injury [4, 8] and among 92 reported abdominal wounds in the Korean conflict; the bladder was involved in 11% of cases [8]. Bladder injury cases in Kuwait during the first Gulf War (1991) were 11% of all GU injuries among Iraqi wounded and 17% among US wounded [9, 10]. However, in modern conflicts in which body armor is universally used, the rate of bladder injuries is well below 2% [4].…”

“…Among US soldiers in the Iraq war, just the opposite was found, with 83% of the GU injuries due to fragmentation injuries and mines [9, 12]. …”

“…Our surgical technique reflects what is routinely done in many studies [5, 6, 9, 10, 13, 17], except that we used only suprapubic drainage in more severe and massive bladder injuries, and no damage control principles were required. Complications occurred in 7 out of the 64 bladder injuries (11%), representing 5% of the surgically repaired cases, and appeared lower than rates described elsewhere which can range as high as 33% [6, 9].…”