Introduction: An explosive is a device designed to inflict injury through generating either significant thermal injury, projectile debris and/or shockwave force following detonation. The combination of clinical findings can be described comprehensively as a blast injury. We investigated the historical relationship between blast trauma and the evolution of genitourinary (GU) trauma care.
Methods: We conducted a review of the literature of GU injury with a particular focus on key terms: blast injury, GU trauma, and battlefield medicine. A review of textbooks and peer-reviewed articles was performed. Department of Defense records and Centers for Disease Control archives were reviewed.
Results: The first explosives in warfare were utilized in ancient China, circa 618–907 C. E., during the Tang dynasty. The Revolutionary and Civil Wars had infrequent explosive blast conflicts with urotrauma accounting for less than 1% of injuries. Civil War GU trauma frequently relied on diverting urine by perineal urethrostomy or suprapubic cystostomy. Artillery in WWI was responsible for two-thirds of all battle casualties and greatly increased the incidence of GU injury. During this time, renal injuries were seldom surgically repaired, resulting in high mortality rates. WWII marked the incorporation of antibiotics and muscle flaps to cover GU injuries. Nuclear blast injury was introduced during WWII with the subsequent addition of radiation-induced GU sequelae. Vascular reconstructive techniques were first introduced during the Korean War. Landmines in the Korean and Vietnam Wars marked further increases in GU injuries but correlated with decreased overall mortality due to improved expeditious care with the use of mobile army surgical hospital (MASH) units and helicopter evacuation. The implementation of Kevlar body armor during the Gulf War decreased overall casualties, but also led to an increase in the incidence of external genitalia blast injuries. This trend continued with nearly three-quarters of battle injuries being due to an explosive mechanism during U.S. involvement in Afghanistan and Iraq. The resulting complex cases utilized the technique of phallic reconstruction and the eventual first penile/scrotal transplantation due to GU trauma.
Conclusions: Over the centuries, the increased incidence of advances in technological warfare has coincided with GU blast trauma. The increased GU blast trauma is juxtaposed with improved surgical technique, technological innovations and improved urologic care. Source of