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| Study Maps ‘Uniquely Devastating’ Genital Injuries Among Troops | Study Maps ‘Uniquely Devastating’ Genital Injuries Among Troops |
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| A new report on one of the most dreaded war wounds finds that 1,367 men in the United States military suffered injuries to their genitals or urinary tract in Iraq or Afghanistan from 2001 to 2013, mostly from bomb blasts. More than a third of the injuries were severe. | A new report on one of the most dreaded war wounds finds that 1,367 men in the United States military suffered injuries to their genitals or urinary tract in Iraq or Afghanistan from 2001 to 2013, mostly from bomb blasts. More than a third of the injuries were severe. |
| The report, published this week by military researchers in The Journal of Urology, is thought to be the most comprehensive review of so-called genitourinary injuries in veterans. The problem was recognized before, but the extent was uncertain. | The report, published this week by military researchers in The Journal of Urology, is thought to be the most comprehensive review of so-called genitourinary injuries in veterans. The problem was recognized before, but the extent was uncertain. |
| The number of cases is “unprecedented” and the injuries “uniquely devastating” because they can impair a man’s ability to have sex, father children or urinate normally, according to the report. Most of the wounded men — 94 percent — were 35 or younger, in “their peak years of sexual development and reproductive potential,” the report said, adding that the psychological toll was especially heavy in such young men. | |
| Researchers say these men are at high risk for suicide. | Researchers say these men are at high risk for suicide. |
| More veterans have these injuries now than in the past because more are surviving than during previous wars, as a result of better body armor and battlefield medicine. Another reason for the increase, according to the report, is that the often rough terrain in Afghanistan forced troops to patrol on foot, which left the soldiers’ groin areas vulnerable to explosions from bombs planted in the ground. Many pelvic injuries occurred during the troop surge there in 2009 and 2010. | More veterans have these injuries now than in the past because more are surviving than during previous wars, as a result of better body armor and battlefield medicine. Another reason for the increase, according to the report, is that the often rough terrain in Afghanistan forced troops to patrol on foot, which left the soldiers’ groin areas vulnerable to explosions from bombs planted in the ground. Many pelvic injuries occurred during the troop surge there in 2009 and 2010. |
| The figures in the report come from records in the Department of Defense Trauma Registry. Of the 1,367 genitourinary injuries reported, 73 percent involved the external genitals. More than a third of the men had at least one injury that was considered severe; 129 lost one of their testes, 17 lost both and 86 had severe injuries to the penis. Fewer than five lost the penis. | The figures in the report come from records in the Department of Defense Trauma Registry. Of the 1,367 genitourinary injuries reported, 73 percent involved the external genitals. More than a third of the men had at least one injury that was considered severe; 129 lost one of their testes, 17 lost both and 86 had severe injuries to the penis. Fewer than five lost the penis. |
| Many had other wounds, as well, including traumatic brain injuries, pelvic fractures, colorectal damage and leg amputations. | |
| “Many of these have been my patients,” said one of the study’s authors, Dr. Steven J. Hudak, a surgeon and a lieutenant colonel at Brooke Army Medical Center in San Antonio. “We are trying to tell their story and display the burden of the problem.” | “Many of these have been my patients,” said one of the study’s authors, Dr. Steven J. Hudak, a surgeon and a lieutenant colonel at Brooke Army Medical Center in San Antonio. “We are trying to tell their story and display the burden of the problem.” |
| Doctors at several medical centers hope to offer penis transplants from deceased organ donors to wounded veterans. The operation has been performed only once in the United States, last year at the Massachusetts General Hospital in Boston. The transplant recipient was not a veteran, but a man whose penis had been amputated because of cancer. He is doing well, and two more men are on the waiting list — another cancer patient, and a burn victim. | Doctors at several medical centers hope to offer penis transplants from deceased organ donors to wounded veterans. The operation has been performed only once in the United States, last year at the Massachusetts General Hospital in Boston. The transplant recipient was not a veteran, but a man whose penis had been amputated because of cancer. He is doing well, and two more men are on the waiting list — another cancer patient, and a burn victim. |
| Johns Hopkins University in Maryland has not yet performed the surgery, but a young man wounded in Afghanistan is on its waiting list. | Johns Hopkins University in Maryland has not yet performed the surgery, but a young man wounded in Afghanistan is on its waiting list. |
| Dr. Hudak said it was not clear how many veterans would actually need penis transplants or be medically eligible for them. Although there were 86 severe injuries to the penis documented in the report, many were considered repairable. | Dr. Hudak said it was not clear how many veterans would actually need penis transplants or be medically eligible for them. Although there were 86 severe injuries to the penis documented in the report, many were considered repairable. |
| In recent years, the military started providing better gear, essentially Kevlar underpants, to protect the pelvic area. One layer, the pug — protective undergarment — goes inside. The next layer, the pog — protective outer garment — is thicker and is worn over the soldier’s combat trousers. | In recent years, the military started providing better gear, essentially Kevlar underpants, to protect the pelvic area. One layer, the pug — protective undergarment — goes inside. The next layer, the pog — protective outer garment — is thicker and is worn over the soldier’s combat trousers. |
| Male and female veterans with genitourinary injuries are being studied as part of a Defense Department project called “TOUGH,” for Trauma Outcomes and Urogenital Health. Women, who are less likely to suffer these types of injuries, are being studied separately and will be the subject of later report, according to Dr. Hudak. | Male and female veterans with genitourinary injuries are being studied as part of a Defense Department project called “TOUGH,” for Trauma Outcomes and Urogenital Health. Women, who are less likely to suffer these types of injuries, are being studied separately and will be the subject of later report, according to Dr. Hudak. |
| A new finding in the report is that blast injuries to the pelvis may have a delayed effect that destroys fertility even if there is no obvious external damage. The authors wrote that they had seen some men who were previously fertile and had blast injuries that appeared to leave the testicles unharmed, but whose testicles later atrophied and stopped making sperm. | A new finding in the report is that blast injuries to the pelvis may have a delayed effect that destroys fertility even if there is no obvious external damage. The authors wrote that they had seen some men who were previously fertile and had blast injuries that appeared to leave the testicles unharmed, but whose testicles later atrophied and stopped making sperm. |
| “For many of these men, paternity is no longer possible without the use of donor sperm, which is not a covered benefit for current or former United States service members,” the report said. | |
| In the British military, doctors routinely collect and freeze sperm from men with testicular injuries as soon as possible after the injury, in case the testes stop working. The soldier’s consent at the time is not needed, so this can be done even while he is unconscious. The United States does not allow doctors to collect sperm from troops without their consent. | In the British military, doctors routinely collect and freeze sperm from men with testicular injuries as soon as possible after the injury, in case the testes stop working. The soldier’s consent at the time is not needed, so this can be done even while he is unconscious. The United States does not allow doctors to collect sperm from troops without their consent. |
| The Defense Department, after recognizing that some service members were losing their ability to have children, created a pilot program last year to pay for freezing sperm or eggs before deployment. | The Defense Department, after recognizing that some service members were losing their ability to have children, created a pilot program last year to pay for freezing sperm or eggs before deployment. |
| In September, Congress passed a law allowing fertility treatments, including in vitro fertilization, for veterans with service-related infertility — something that had previously been banned. But the law will expire after two years. | In September, Congress passed a law allowing fertility treatments, including in vitro fertilization, for veterans with service-related infertility — something that had previously been banned. But the law will expire after two years. |
| “The amount of resiliency and inner and outer strength and personal courage the patients I’ve been asked to care for is quite inspiring, the courage they display when they face these things that 20-year-olds otherwise would not have to face,” Dr. Hudak said. | “The amount of resiliency and inner and outer strength and personal courage the patients I’ve been asked to care for is quite inspiring, the courage they display when they face these things that 20-year-olds otherwise would not have to face,” Dr. Hudak said. |