Traumas geniturinários em operações militares
Resumo
A frequência e os traumas geniturinários (GU) evoluíram juntamente com a mudança da natureza dos conflitos, passando do emprego de projétil de arma de fogo (PAF) durante as guerras para os dispositivos de explosivos improvisados (IED) nos combates operacionais. Objetivos e Método: Entender a epidemiologia dos traumas GU no contexto das operações militares, analisando os dados dos últimos 10 anos de artigos publicados em língua inglesa nos bancos de dados PubMed, SciELO and Google Scholar, com as seguintes palavras-chaves: genitourinary injury, military, wartime, combat operation, Iraqui Freedom (OIF) e EnduringFreedom (OEF). Desenvolvimento: A prevalência de lesões GU foi de 5% na OIF e OEF, predominando genitália externa [escroto (55,6%), testículos (33,0%), pênis (31,0%) e uretra (9,1%)] vs. rins (21,1%). Entre as mulheres (1,4% do total) a maioria foram renais (57%) ou vulvovaginais (33%). A mediana da gravidade da lesão foi significativamente maior por explosivos que projétil (34 e 18, respectivamente, P <0,001) e em 86% geraram múltiplas lesões. A lesão politraumática grave foi comum entre os homens (36,7%), predominando fratura pélvica (25,0%) e amputação de membros inferiores (28,3%); nas mulheres foram acometimento colorretal (25%) e amputação de membros inferiores (10%). Conclusão: Houve alteração na prevalência predominante das lesões renais nas guerras para lesões de genitálias externas no combate. A complexidade dos traumas requer procedimentos reconstrutivos por etapas e a associação com outros traumas impõe a necessidade de multidisciplinaridade no tratamento desses pacientes. Os desafios para a medicina militar são pesquisar e desenvolver tecnologias para prevenir e tratar essas lesões, devido às sequelas física, psicológica e sexual.
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