Traumas geniturinários em operações militares

  • Henrique Cunha Vieira Essex
  • Maria Aparecida Ribeiro Vieira
  • Diogo de Souza Leão da Rocha

Abstract

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.

Downloads

Download data is not yet available.

References

AL-AZZAWI, I.S.; KORAITIM, M.M. Urethral and penile war injuries: The experience from civil violence in Iraq. Arab Journal of Urology, v.12, p. 149-154, jan. 2014.

ARTHURS, Z. et al. The use of damage-control principles for penetrating pelvic battlefield trauma. The American Journal of Surgery, n. 191, p. 604-609, jan. 2006.

BALA, M. et al. Abdominal trauma after terrorist bombing attacks exhibits a unique pattern of injury. Ann Surg, v. 248, n. 2, p.303-9, ago. 2008.

C

BALZANO, F. L; HUDAK, S.J. Military genitourinary injuries: past, present, and future. Translational andrology and urology, v. 7, n.4, p. 646-652, ago. 2018.

BIJURLIN, M. A.; FANTUS, R. J.; MELLETT, M. M. Bjurlin MA, Fantus RJ, Mellett MM, Goble SM: Genitourinary injuries in pelvic fracture morbidity and mortality using the National Trauma Data Bank. J Trauma Acute Care Surg, v. 67, n. 5, p. 1033-9, nov. 2009.

BRAY, J. Genitourinary Trauma: A battle cry for integrated collaborative veteran-centric care. Journal of Mens Health, v. 10, n.4, 2013

BRAYNT, et al. The Psychiatric Sequelae of Traumatic Injury. American Journal of Psychiatry, v. 167, n. 3, p. 312-20, mar. 2010.

CARVALHO, J. Dismounted complex blast injury: Report of the Army dismounted complex blast injury task force. Fort Sam Houston, 2011.

DAVIS, J. M. et all. Skeletal Trauma Research Consortium. Factors associated with mortality in combat-related pelvic fractures. J Am Acad Orthop Surg, v. 20, p. S7-12, 2012.

JANAK, J.C.; ORMAN J.A.; SODERDAHL, D. W.; HUDAK S.J. Epidemiology of Genitourinary Injuries among Male U.S. Service Members Deployed to Iraq and Afghanistan: Early Findings from the Trauma Outcomes and Urogenital Health (TOUGH) Project. The Journal of urology, v. 197, n. 2, p. 414-419, set. 2017.

JACKSON, B. et al. Urinary Tract Infections After Combat-related Genitourinary Trauma. Open Forum Infectious Diseases, v. 4, n. 1, p. S345, out. 2017

HAN, J. S. et al. Genitourinary Trauma in the Modern Era of Warfare. Journal of Mens Health, v. 10, n. 4, 2013

HUDAK, S.J.; HAKIM, S. Operative management of wartime genitourinary injuries at bald air force theatre hospital, 2005 to 2008. Journal of Urology, v. 182, p.180-183, jul. 2009

HOLCOMB, J. B., et al. Military, civilian, and rural application of the damage control philosophy. Mil Med, v. 166, p. 409, 2001

NNAMANI, N. S. et al. Genitourinary injuries and extremity amputation in Operations Enduring Freedom and Iraqi Freedom: Early findings from the Trauma Outcomes and Urogenital Health (TOUGH) project. J Trauma Acute Care Surg, v.81, n.2, p. s95-s99, nov. 2016.

PAQUETTE, E. L. Genitourinary trauma at a combat support hospital during Operation Iraqi Freedom: the impact of body armor. J Urol, v. 177, n.6, p. 2196-9, jun. 2007

PEREIRA, B. M., et al. A review of ureteral injuries after external trauma. Scand J Trauma Resusc Emerg Med, v. 18, p. 6, 2010.

C

REED, A. M., et al. 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. Military Medicine, v. 183, n. 7-8, p. 301-309, jul. 2018.

SHARMA, M.D. The management of genitourinary war injuries: a multidisciplinary consensus. J R Army Med Corps, v. 159, n.1, p. i57-i59, jul. 2013

SERKIN, F. B. et al. Combat urologic trauma in US military overseas contingency operations. Journal of Trauma. v. 69, n. 1, p. s175-8, jul. 2010

TURNER, C.A. et al. Genitourinary Surgical Workload at Deployed U.S. Facilities in Iraq and Afghanistan, 2002–2016. Military Medicine, v. 184, n. 1-2, p. e179-e185, jan. 2019.

WAXMAN, S. Lower urinary tract injuries in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). Mil Med, v.177, n.6, p.621-3, jun. 2012

WAXMAN, S., et al. Penetrating trauma to the external genitalia in Operation Iraqi Freedom. International Journal of Impotence Research, v. 21, p. 145–148, nov 2009

WILCOX, S.L.; REDMON S.; HASSAN, A.M. Sexual functioning in military personnel: preliminary estimates and predictors. Journal of Sexual Medicine., v. 1, n. 10, p. 537-45, out. 2017

WILLIAMS, M.; JEZIOR, J. Management of combat-related urological trauma in the modern era. Nature Reviews Urology, v.10, p. 504–512, jul. 2013.

Published
2021-03-09
How to Cite
Vieira, H. C., Vieira, M. A. R., & Rocha, D. de S. L. da. (2021). Traumas geniturinários em operações militares. EsSEX: Revista Científica, 4(6), 52-60. Retrieved from https://ebrevistas.eb.mil.br/RCEsSEx/article/view/3113