Battlefield urologic injuries: The Gulf War experience

Background: We sought to ascertain the incidence and type of urologic injuries requiring operations during the Gulf War. Study Design: Of the 31 United States urologic surgeons deployed to the Persian Gulf theater of operations, 11 responded to a survey concerning the type and frequency of urologic trauma surgical procedures. Results: The 11 urologic surgeons performed a total of 55 surgical procedures, 30 of which were for urologic injuries. Most injuries were due to fragmentation devices. Only 17% involved the kidney and none involved the ureter; 83% involved the pelvic organs and external genitalia. The majority of surgical procedures performed for these injuries were conservative (organ sparing). Anecdotal observations by the surgeons suggested that the use of the flak vest may have led to a shift away from abdominal injuries to injuries of the pelvis and genitalia. Conclusions: Urologic injuries in the Gulf War primarily involved the pelvis and genitalia and were frequently managed conservatively. The prevalence of fragmentation injuries and use of the flak vest may explain this observation.