Clinical Study of Carbon Dioxide Laser and Pelvic Floor Function Exercise for Urinary Incontinence Complicated by Genitourinary Syndrome of Menopause.

BACKGROUND: Urinary incontinence is common in patients with genitourinary syndrome of menopause (GSM). A retrospective cohort study was conducted to analyse the clinical efficacy of carbon dioxide laser combined with pelvic floor functional exercise for GSM with urinary incontinence, aiming to provide evidence for its clinical treatment. METHODS: Patients diagnosed with GSM and urinary incontinence and admitted to our hospital from January 2021 to December 2022 were included and allocated to a control group (pelvic floor function exercise) and combined group (carbon dioxide laser combined with pelvic floor function exercise). Confounding factors among the groups were balanced by the propensity score matching method. The clinical efficacy, GSM scale scores, urinary indicators, urinary incontinence quality of life scale (I-QOL) scores and the degree of urinary incontinence of the groups were compared. RESULTS: A total of 192 patients were included in this study, and 36 cases were included in each group after the propensity scores were matched. No statistical difference in baseline data was found between the groups (p > 0.05). The combined group had higher total effective rate and I-QOL scores but lower GSM symptom scale scores than the control group. Urination during daytime and nighttime was less frequent in the combined group than in the control group, which showed a lower degree of urinary incontinence (p < 0.05). CONCLUSIONS: Combining carbon dioxide laser treatment with pelvic floor exercises is potentially effective for patients with GSM and urinary incontinence. This combined approach not only alleviated GSM and urinary incontinence symptoms but also reduced the severity of urinary incontinence, promoted bladder function recovery and enhanced overall quality of life.

Pudendal nerve neurolysis outcomes for urogenital and rectal disorders in patients suffering from pudendal nerve entrapment: A systematic review.

PURPOSE: Pudendal neuropathy is an uncommon condition that exhibits several symptoms depending on the site of nerve entrapment. This study aims to evaluate the efficacy of pudendal nerve neurolysis (PNN) in improving lower urinary tract symptoms, anal and/or urinary incontinence, and sexual dysfunctions. MATERIALS AND METHODS: A systematic literature search was performed on 20 May 2023 using Scopus, PubMed, and Embase. Only English and adult papers were included. Meeting abstracts and preclinical studies were excluded. RESULTS: Twenty-one papers were accepted, revealing significant findings in the field. The study identified four primary sites of pudendal nerve entrapment (PNE), with the most prevalent location likely being at the level of the Alcock canal. Voiding symptoms are commonly exhibited in patients with PNE. PNN improved both urgency and voiding symptoms, and urinary and anal incontinence but is less effective in cases of long-standing entrapment. Regarding sexual function, the recovery of the somatic afferent pathway results in an improvement in erectile function early after neurolysis. Complete relief of persistent genital arousal disorder occurs in women, although bilateral PNN is necessary to achieve the efficacy. PNN is associated with low-grade complications. CONCLUSIONS: PNN emerges as a viable option for addressing urinary symptoms, fecal incontinence, erectile dysfunction, and female sexual arousal in patients suffering from PNE with minimal postoperative morbidity.

Vaginal CO2 laser therapy for genitourinary syndrome in breast cancer survivors-VagLaser study protocol: a randomized blinded, placebo-controlled trial.

BACKGROUND: Vaginal CO2 laser therapy is a new treatment option for genitourinary syndrome of menopause. Its potential is particularly interesting in breast cancer survivors, where existing treatment options often are insufficient as hormonal treatment is problematic in these women. The objective of this study is to investigate the effectiveness of vaginal laser treatment for alleviation of genitourinary syndrome of menopause in breast cancer survivors treated with adjuvant endocrine therapy. The secondary objective is to explore the importance of repeated vaginal laser treatment and the long-term effects in this patient population. METHODS: VagLaser consist of three sub-studies; a dose response study, a randomized, participant blinded, placebo-controlled study and a follow-up study. All studies include breast cancer survivors in adjuvant endocrine therapy, and are conducted at the Department of Obstetrics and Gynecology, Randers Regional Hospital, Denmark. The first participant was recruited on 16th of February 2023. Primary outcome is vaginal dryness. Secondary subjective outcomes are vaginal pain, itching, soreness, urinary symptoms and sexual function. Secondary objective outcomes are change in vaginal histology (punch biopsy), change in vaginal and urine microbiota, and change in vaginal pH. DISCUSSION: More randomized controlled trials, with longer follow-up to explore the optimal treatment regimen and the number of repeat vaginal laser treatments for alleviation the symptoms of genitourinary syndrome of menopause in breast cancer survivors treated with endocrine adjuvant therapy, are needed. This study will be the first to investigate change in vaginal and urine microbiota during vaginal laser therapy in breast cancer survivors. TRIAL REGISTRATION: ClinicalTrials.gov: NCT06007027 (registered 22 August, 2023). PROTOCOL VERSION: Version 1, Date 13.11.2023.

Effective Prevention of Recurrent UTIs With Vaginal Estrogen: Pearls for a Urological Approach to Genitourinary Syndrome of Menopause.

OBJECTIVE: To review the available data related to the prevention of recurrent urinary tract infection (rUTI) in postmenopausal women with vaginal estrogen preparations and provide the urologic community with the confidence to identify and treat genitourinary syndrome of menopause (GSM). MATERIALS AND METHODS: A literature search of MEDLINE and the Cochrane Central Register of Controlled Trials databases was performed to identify studies utilizing vaginal estrogen in the treatment of urological conditions related to rUTI and GSM. RESULTS: In the setting of untreated GSM, the etiology of rUTIs (at least 3 episodes of UTIs in 12 months or at least 2 episodes in 6 months) is not fully elucidated, but estrogen deficiency is a contributing factor. The diagnosis of GSM is primarily a clinical diagnosis supported by other objective findings including: a vaginal pH >5, decreased content of superficial cells, and/or increased proportion of parabasal cells on vaginal maturation index. Local vaginal estrogen, dehydroepiandrosterone (prasterone), and ospemifene are commonly used GSM treatments. Thirty-one trials were identified utilizing estrogen preparations for rUTI in postmenopausal women. CONCLUSION: Overall, multiple randomized clinical trials have successfully been completed to show the efficacy of local estrogen preparations for the treatment of rUTIs. This high yield review provides a framework for assessing GSM, prescribing recommendations for local vaginal hormone preparations, and a summary of the substantial evidence supporting the new 2019 American Urological Association/Canadian Urological Association/Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction Guidance for local vaginal estrogen use for rUTI.

CO2 laser and the genitourinary syndrome of menopause: a randomized sham-controlled trial.

PURPOSE: This study aimed to clarify the efficacy of intravaginal CO2-laser treatment in postmenopausal women with genitourinary syndrome of menopause (GSM). MATERIALS AND METHODS: This double-blind, randomized, sham-controlled trial included postmenopausal women diagnosed with GSM and bothersome dryness and dyspareunia. Treatment consisted of three sessions. Active CO2-laser treatments (active group) were compared to sham treatments (sham group) with the primary endpoints being changes in dryness and dyspareunia intensity, as assessed by the 10-cm visual analog scale. Secondary endpoints were as follows: changes in Female Sexual Function Index (FSFI; total score and all domains), itching, burning, dysuria, and Urogenital Distress Inventory (UDI-6); incidence of symptoms; and presence of adverse events. All outcomes were evaluated at baseline and 4 months post baseline. RESULTS: Fifty-eight women (28 in the active group and 30 in the sham group) were eligible for inclusion. In the active group, dryness, dyspareunia, FSFI (total score), itching, burning, dysuria, and UDI-6 were significantly improved (mean [standard deviation] -5.6 [2.8], -6 [2.6], 12.3 [8.9], -2.9 [2.8], -2.3 [2.8], -0.9 [2.1], and -8.0 [15.3], respectively). In the sham group, dryness, itching, and burning were significantly improved (-1.9 [2], -1.4 [1.9], and -1 [1.9], respectively). All changes were in favor of the active group. After completion of the protocol, the proportion of participants with dryness, dyspareunia, and sexual dysfunction was significantly lower in the active group compared to those in the sham group (all p < 0.005). CONCLUSIONS: CO2 laser could be proposed as an effective alternative treatment for the management of GSM as it is superior to sham treatments.

Synanthropic Clogmia albipunctata Causing Urogenital and Gastrointestinal Myiasis

Being a synanthropic cosmopolitan fly of tropical origin, Clogmia albipunctata is an aquatic species that is commonly found in moisture-rich places such as inside a house, sewage treatment plants, and hospitals. C. albipunctata can cause urogenital, intestinal, and even nasopharyngeal accidental myiasis under non-hygienic conditions or if a person consumes substandard food. Its larvae enter the human body via bodily cavities such as rectum, genitalia, or urinary canal, thereby leading to the development of infestation. This can in turn cause haematuria, bloody stool, vomiting and fever, with the appearance of larvae in urine and faeces. Here, we present the case of a 43-year-old woman with infection in the urogenital and gastrointestinal systems by the fourth instar larvae of C. albipunctata. To the best of our knowledge, this is the first report of myiasis caused by this species in Turkey. This study will provide general information about the biology of this species and methods to recognize it.

Estrogen receptors in urogenital schistosomiasis and bladder cancer: Estrogen receptor alpha-mediated cell proliferation.

Estrogen-like metabolites have been identified in S. haematobium, the helminth parasite that causes urogenital schistosomiasis (UGS) and in patients´ blood and urine during UGS. Estrogen receptor (ER) activation is enriched in the luminal molecular subtype bladder cancer (BlaCa). To date, the significance of ER to these diseases remains elusive. We evaluated ERα and ERß expression in UGS-related BlaCa (n = 27), UGS-related non-malignant lesions (n = 35), and noninfected BlaCa (n = 80). We investigated the potential of ERα to recognize S. haematobium-derived metabolites by docking and molecular dynamics simulations and studied ERα modulation in vitro using 3 BlaCa cell lines, T24, 5637 and HT1376. ERα was expressed in tumor and stromal cells in approximately 20% noninfected cases and in 30% of UGS-related BlaCa, predominantly in the epithelial cells. Overall, ERα expression was associated with features of tumor aggressiveness such as high proliferation and p53 positive expression. ERα expression correlated with presence of schistosome eggs. ERß was widely expressed in both cohorts but weaker in UGS-related cases. molecular dynamics simulations of the 4 most abundant S. haematobium-derived metabolites revealed that smaller metabolites have comparable affinity for the ERα active state than 17ß-estradiol, while the larger metabolites present higher affinity. Our in vitro findings suggested that ERα activation promotes proliferation in ERα expressing BlaCa cells and that this can be reverted with anti-estrogenic therapy. In summary, we report differential ER expression between UGS-related BlaCa and noninfected BlaCa and provide evidence supporting a role of active ERα during UGS and UGS-induced carcinogenesis.

Use of a shaving technique for surgical management of partial ureteral obstruction due to endometriosis.

OBJECTIVE: To illustrate the surgical management of advanced endometriosis causing extrinsic ureteral compression. DESIGN: Video description of the case, demonstration of the surgical technique, reevaluation at 14-year follow-up, and review of urogenital endometriosis. Patient provided consent for the video recording and publication. This surgical report with no identifying patient data was exempt from Institutional Review Board approval. SETTING: Tertiary referral center. PATIENT(S): A 42-year-old nulligravida with a known history of endometriosis presented with persistent pelvic pain and no other specific symptoms. She had previously undergone a diagnostic laparoscopy demonstrating advanced endometriosis involving multiple organs, including the urinary tract. She was referred to us for further surgical management. Preoperative intravenous pyelogram showed partial obstruction and constriction of a long portion of the midpelvic and distal left ureter with proximal hydroureter, consistent with extrinsic ureteral compression. INTERVENTION(S): The patient underwent operative video laparoscopy using a multipuncture technique, with enterolysis, extensive left ureterolysis, shaving of periureteral constrictive fibrosis and endometriosis, cystoscopy, and placement of left ureteral stent. MAIN OUTCOME MEASURE(S): There was extensive endometriosis and fibrotic adhesions involving the left pelvic sidewall. Proximal hydroureter was noted to the pelvic inlet secondary to severe periureteral fibrosis from the pelvic brim to the bladder meatus, with significant narrowing of the pelvic ureter. The endometriosis was resected using hydrodissection and shaving with a carbon dioxide laser. Histopathologic evaluation of the resection specimens confirmed endometriosis. RESULT(S): An intravenous pyelogram performed 4 weeks postoperatively revealed ureteral patency and resolving hydroureter, and her ureteral stent was removed. Annual renal ultrasounds for the subsequent 2 years were normal. Fourteen years later, she remained asymptomatic on no suppressive treatment. A follow-up intravenous pyelogram was performed and showed a normal urinary tract with bilateral ureteral patency and no recurrent strictures or hydroureter. CONCLUSION(S): In selected cases, conservative shaving of periureteral fibrotic endometriosis avoids ureteral resection and has acceptable outcomes.

Connecting Female Genital Schistosomiasis and Menstrual Hygiene Initiatives.

Effective future control of female genital schistosomiasis (FGS) requires an integrated and multisectoral approach, bringing together HIV, sexual and reproductive health, and reproductive rights sectors. In this article, an underappreciated but important connection between FGS and menstrual hygiene initiatives in Africa is highlighted.

Total Exenteration En Bloc with a Nephrectomy for Locally Advanced Cervical Cancer Invading a Pelvic Kidney-a Case Report and Literature Review.

Introduction: Extended pelvic resection might be the option of choice in patients presenting locally advanced cervical cancer. However, the possibility of a co-existence of an ectopic, pelvic kidney that is invaded by such a tumor is extremely rare. Case Presentation: A 54-year-old female patient, diagnosed with locally advanced cervical cancer in the presence of a pelvic kidney, was submitted to surgery with curative intent. A large, abscessed cervical tumor invading the urinary bladder and the rectum was found, so a total exenteration was planned. Intraoperatively, tumor invasion of the left kidney, which was found in an ectopic, pelvic position was also encountered; therefore, total pelvic exenteration in association with a left nephrectomy was successfully performed. Conclusions: The presence of an ectopic, pelvic disposition of the kidney makes it susceptible to be invaded by locally advanced pelvic tumors; in such cases, a nephrectomy might also be needed.

Current knowledge of medical complications in adults with achondroplasia: A scoping review.

This article provides an overview of the current knowledge on medical complications, health characteristics, and psychosocial issues in adults with achondroplasia. We have used a scoping review methodology particularly recommended for mapping and summarizing existing research evidence, and to identify knowledge gaps. The review process was conducted in accordance with the PRISMA-ScR guidelines (Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews). The selection of studies was based on criteria predefined in a review protocol. Twenty-nine publications were included; 2 reviews, and 27 primary studies. Key information such as reference details, study characteristics, topics of interest, main findings and the study author's conclusion are presented in text and tables. Over the past decades, there has only been a slight increase in publications on adults with achondroplasia. The reported morbidity rates and prevalence of medical complications are often based on a few studies where the methodology and representativeness can be questioned. Studies on sleep-related disorders and pregnancy-related complications were lacking. Multicenter natural history studies have recently been initiated. Future studies should report in accordance to methodological reference standards, to strengthen the reliability and generalizability of the findings, and to increase the relevance for implementing in clinical practice.

[Clinical profile of urinary incontinence in women hospitalized in the University Clinics of Kinshasa from 2015 to 2016]. / Profil clinique de l´incontinence urinaire de la femme aux Cliniques Universitaires de Kinshasa de 2015 à 2016: une étude descriptive rétrospective.

Urinary Incontinence (UI) in women is a very common disease. Given the shortage of epidemiological and clinical data in our environment, we here provide an update on the status of this disease and its management at the University Clinics of Kinshasa. We conducted a descriptive study in the University Clinics of Kinshasa from January 2015 to December 2016. The annual rate of IU was 1.3% (23/1813 patients). We included 15 cases whose medical files were usable and whose average age was 49.2±20.5 years, ranging between 15 and 98 years. IU affected multiparous women (53.4%), pauciparous women (26.7%), primiparous women (6.7%) and nulliparous women (13.3%) and the median date of onset of IU was 3 months. Urge incontinence affected 33.3% of patients and effort incontinence 13.3%. Among diagnoses associated with UI, the most common were urogenital infections (46.7%), cystocele (20%) and chronic pelvic pain (20%). These patients received antibiotic therapy (60%), anticholinergics drugs (20%), and pelviperineal rehabilitation (20%) as well as surgical treatment. UI is underestimated at the University Clinics of Kinshasa. The most commonly diagnosed IUs are effort and urge incontinence. Patient´s management is based on multidisciplinary approach.

Critical analysis of methods for assessing genitourinary syndrome of menopause used in clinical trials.

OBJECTIVE: The aim of the study was to determine the most used methods for assessing genitourinary syndrome of menopause by the latest studies on the subject, and to critically assess their differences and comparability. METHODS: A narrative review of the literature was conducted, employing the terms genitourinary syndrome, vaginal atrophy, urogenital atrophy, and atrophic vaginitis, to analyze methods used to assess treatment efficacy. Only controlled randomized clinical trials assessing improvement of genitourinary syndrome of menopause, conducted in the last 5 years, and considering all types of treatment, were selected. RESULTS: Of the 37 studies included, 24 combined both objective and subjective methods thereby ensuring reproducibility and efficacy of symptom relief of the treatment analyzed. The vaginal maturation index was the most used objective method, followed by vaginal pH. One study used histological and immunohistochemistry tests. Regarding subjective methods, the "Most bothering Symptom" and other questionnaires as the Female Sexual Function Index for sex life, the Verbal Rating Scale, among others, were used. CONCLUSIONS: Despite the heterogeneity observed, particularly for subjective assessment of symptoms, there was a tendency to standardize methods and to use an objective method together with a subjective, which seems to be fundamental to guarantee reproducibility and comparability of results of each treatment analyzed. Histological and immunohistochemistry tests may be an option as an objective method in further studies, to better assess thickness, vascularization, among other parameters.

Sexual function specific questionnaires as a useful tool in management of urogynecological patients - Review.

Urinary incontinence, fecal incontinence and pelvic organ prolapse are one of the most prevalent gynaecological conditions and constitute a huge global problem affecting approximately 20% of women, increasing with age. Pelvic floor disorders can have negative influence on women's quality of life, decreasing social, psychological, occupational, physical and sexual well-being. Pelvic organ prolapse results in anatomical changes to the urogenital tract and it is perceived to be one of the main factor influencing sexual function. Because treatment of pelvic organ prolapse and complications related to it may cause discomfort, the most important outcome of the therapy, including anatomical restoration, is relief in symptoms and improvement in quality of life. Psychometrical instruments for measuring health-related quality of life are essential during evaluation of women with pelvic floor disorders. Assessing severity of pelvic organ prolapse, its' impact on quality of life, therapy planning and the inclusion of sexuality questionnaires as an outcome measure in urogynecological patients allows to analyze impact of surgical treatment on women's sexual life. For this purpose, condition - specific instruments were developed and published. The aim of this study is to present particular questionnaires and their proper practical application in clinical practice, especially before surgical treatment and follow-up. Furthermore, those questionnaires are essential in order to describe patients' expectations during tailored clinical management.

Marked reduction in fertility among African women with urogenital infections: A prospective cohort study.

BACKGROUND: There is paucity of data on risk factors for reduced fertility in low-income countries. OBJECTIVE: To investigate factors associated with fertility among women in rural north eastern Tanzania. SUBJECTS AND METHODS: A cohort of 1248 non-pregnant women was followed with urine pregnancy testing every third month or more regularly if they reported a missed menstrual period. Pregnancy was confirmed with trans-abdominal ultrasound. Information regarding general health, socioeconomic status and obstetric-gynaecological history was collected. Factors associated with conceiving within 180 days were identified using multivariate logistic regression analyses. RESULTS: Among the 1248 women, 736 were followed for 180 days and 209 of these had an ultrasound confirmed pregnancy. During the follow-up period, 169/736 women were diagnosed with urogenital infections, including suspected sexually transmitted or reproductive tract infections, urinary tract infection, and vaginal candidiasis. Urogenital infections were significantly associated with reduced odds of conceiving within 180 days (adjusted OR (AOR) 0.21, 95% CI 0.11-0.36). Being above 30 years of age was also negatively associated with odds of conceiving (AOR 0.45, 95% CI 0.26-0.77). In contrast, women who recently stopped using hormonal contraceptives (AOR 2.86, 95% CI 1.45-5.70) and women with low socioeconomic status (AOR 1.56, 95% CI 1.04-2.33) were significantly more likely to become pregnant within 180 days. CONCLUSION: Urogenital infection seems to be a major health factor associated with reduced chances of conceiving. Considering the availability of effective treatment options for these diseases, public health authorities should increase awareness of diagnostic tools in settings with limited resources in order to improve fertility.

Nonclinical Barriers to Care for Neurogenic Patients Undergoing Complex Urologic Reconstruction.

OBJECTIVE: To identify nonclinical factors affecting postoperative complication rates in patients with neurogenic bladder undergoing benign genitourinary (GU) reconstruction. METHODS: Adult patients with neurogenic bladder undergoing benign GU reconstruction between October 2010 and November 2015 were included. Patients were excluded if a diversion was performed for malignancy, if patients had a history of radiation or if a new bowel segment was not utilized at the time of the operation. Clinical and nonclinical factors were abstracted from the patients' electronic medical records. Health literacy was assessed via the Brief Health Literacy Screen (BHLS), a validated 3-question assessment. Education, marital status, and distance from the medical center were also queried. RESULTS: Forty-nine patients with a neurogenic bladder undergoing complex GU reconstruction met inclusion and exclusion criteria. On average, patients lived 111 miles (standard deviation 89) from the hospital. Overall, mean BHLS score was 10.4 (standard deviation 4.6) with 35% of patients scoring a BHLS of ≤9. Mean years of educational attainment was 9.7, and only 31% of patients completed high school education. In the first month after surgery, 37 patients (76%) experienced a complication, and 22% were readmitted; however, analysis of complication data did not identify an association between any nonclinical variables and complication rates. CONCLUSION: Nonclinical factors including unmarried status, poor health literacy, and marked distance from quaternary care are prevalent in patients with neurogenic bladder undergoing complex GU reconstruction. To mitigate these potential risk factors, the authors recommend acknowledgment of these factors and multidisciplinary support perioperatively to counteract them.

The Effects of a Life Stress Emotional Awareness and Expression Interview for Women with Chronic Urogenital Pain: A Randomized Controlled Trial.

OBJECTIVE: Women with chronic urogenital pain (CUP) conditions have elevated rates of lifetime trauma, relational stress, and emotional conflicts, but directly assessing and treating psychological stress is rarely done in women's health care settings. We developed and tested the effects on patients' somatic and psychological symptoms of a life stress interview that encourages disclosure about stressors and uses experiential techniques to increase awareness of links between stress, emotions, and symptoms. METHODS: In this randomized trial, women with CUP recruited at a multidisciplinary women's urology center received either a single 90-minute life stress interview (N = 37) or no interview (treatment-as-usual control; N = 25). Self-report measures of pain severity (primary outcome), pain interference, pelvic floor symptoms, and psychological symptoms (anxiety and depression) were completed at baseline and six-week follow-up. RESULTS: Differences between the life stress interview and control conditions at follow-up were tested with analyses of covariance, controlling for baseline level of the outcome and baseline depression. Compared with the control condition, the interview resulted in significantly lower pain severity and pelvic floor symptoms, but the interview had no effect on pain interference or psychological symptoms. CONCLUSIONS: An intensive life stress emotional awareness expression interview improved physical but not psychological symptoms among women with CUP seen in a tertiary care clinic. This study suggests that targeting stress and avoided emotions and linking them to symptoms may be beneficial for this complex group of patients.

Practical Applications of Dual-Energy Computed Tomography in the Acute Abdomen.

With new developments in workflow automation, as well as technological advances enabling faster imaging with improved image quality and dose profile, dual-energy computed tomography is being used more often in the imaging of the acutely ill and injured patient. Its ability to identify iodine, differentiate it from hematoma or calcification, and improve contrast resolution has proven invaluable in the assessment of organ perfusion, organ injury, and inflammation.

Urogenital Myiasis Caused by Psychoda albipennis.

Myiasis is one of the reasons for urogenital parasitosis in our country. Psychoda albipennis is a fly that leads to urogenital myiasis. In this case, a 28-year-old female with complaints of dysuria, nausea, vomiting, abdominal pain, and dropping larvae with urine was referred to our hospital. Larvae in the urine sample were macroscopically and microscopically examined. Subsequently, the patient was diagnosed with urogenital myiasis due to P. albipennis fourth phase larvae. The symptoms were relieved with antibiotic and urinal antiseptic treatments. A diagnosis of urogenital myiasis should be considered in patients with urogenital complaints.

Genitourinary Injuries Among Female U.S. Service Members During Operation Iraqi Freedom and Operation Enduring Freedom: Findings from the Trauma Outcomes and Urogenital Health (TOUGH) Project.

Introduction: Until recently, female U.S. service members (SMs) have not been permitted to serve in direct combat roles. However, during Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF), a large number of female SMs have been wounded while serving in combat support roles. This included an unprecedented number of women with genitourinary (GU) injuries. No previous studies have reported either the incidence or clinical picture of these injuries. The objective of this study is to describe the epidemiology of GU injuries among female U.S. SMs during OIF/OEF and understand the potential for increased female GU injuries in future conflicts and the long-term sequelae from these injury patterns. Materials and Methods: The Department of Defense Trauma Registry was reviewed to identify all U.S. SMs diagnosed with GU injury from 2001 to 2013. The Department of Defense Trauma Registry includes data for wounded SMs treated at any U.S. combat support hospital, the in-theater equivalent of a civilian trauma center. Female SMs with ICD-9-CM diagnosis codes and/or Abbreviated Injury Scale codes for GU injury were included. Data on all females with GU injury were reviewed, including battle injury (BI) and non-BI. Basic demographic and injury characteristics were reported. Results: Among the 1,463 U.S. SMs diagnosed with GU injury while deployed to OIF/OEF, 20 (1.4%) were female (median age: 25 yr; interquartile range 21-27 yr). Of these, nine were BI (45%) and 11 were non-BI (55%). The distribution of injury location was as follows: renal injuries (n = 12), vulvar injuries (n = 3), vaginal injuries (n = 3), perineal injury (n = 1), and bladder injury (n = 1). Median Injury Severity Score was in the severe range of 21 (interquartile range 6-32), and four women (20%) died of their wounds. Important associated injuries included colorectal (n = 5) and lower extremity amputation(s) (n = 2). The most common mechanism of injury among the nine women with GU BI was improvised explosive device blast (n = 6), followed by other explosions (n = 2) and gunshot wound (n = 1). Mechanisms of GU non-BI varied, including gunshot wound (n = 2), fall (n = 2), fire/flame (n = 1), knife wound (n = 1), unintentional machine injury (n = 1), motor vehicle accident (n = 1), sports injury (n = 1), fight (n = 1), and pedestrian injury (n = 1). Conclusion: Female GU injuries comprise a small portion of all GU injuries sustained during OIF/OEF with the most predominant being renal injury. Now that the ground combat exclusion policy has been lifted, these data can be used as a model for the expected injury patterns in future female combatants. Long-term applications for these data include research and development for personal protective equipment and development of a multidisciplinary approach to long-term comprehensive care following GU trauma.