We Need to Learn More About These Wounds that Change Vets' Lives

hospital bed

Dr. Steven J. Hudak, a former U.S. Army lieutenant colonel, is an associate professor of urology at UT Southwestern Medical Center in Dallas, Texas, with a practice focused on urologic trauma, prosthetics and reconstructive genitourinary surgery.

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One of the most intimate and potentially life-changing wounds sustained by combat veterans is among those we know the least about. More service members are surviving injuries to their urinary, genital and reproductive areas because of advancements in battlefield medicine, but our military and veterans' health systems do not fully understand how these injuries impact service members over time. Without that data, we are likely falling short of providing these veterans the treatments and long-term care they've earned.

A team of health care experts, including veterans and military caregivers, recently launched a secure survey designed to fill this critical gap in military health research. The Trauma Outcomes and Urogenital Health (TOUGH) Project needs the help of all veterans who sustained genitourinary (GU) injuries during Operation Iraqi Freedom or Operation Enduring Freedom.

Scientific research has allowed medical professionals to treat injuries such as amputations and explosive injuries with more confidence and a greater understanding of likely outcomes. That does not mean these wounds are easy to care for or live with, but the data allows medical professionals to make more informed decisions about long-term care. This research also gives patients some expectation of how their injuries will progress as they age and what steps they can take to adapt for the future.

Unfortunately for veterans living with long-term consequences of GU injuries, we do not have data about their experiences over time. As an Army surgeon who cared for many of the Iraq and Afghanistan veterans who sustained these injuries, I know how valuable this information would be for better protecting, treating and caring for our veterans.

One of the reasons our leaders have not yet given these injuries the attention they deserve may be because the population of affected veterans seems relatively small. However, in the initial report from the TOUGH Project, we identified nearly 1,500 service members who sustained GU injuries. In some cases, these veterans have lost the natural ability to conceive children, to have sexual intercourse, and/or to maintain full control over their bladder. Like other combat wounds, these injuries can impact the veteran on a daily basis and, perhaps, for the rest of their lives. Our promise to care for those who serve certainly extends to these veterans, regardless of the total number impacted.

GU wounds may also be understudied because they are often hidden from the public eye. Some combat injuries (such as limb amputation) are visible, and veterans have no choice but to make them public, but GU wounds can often be concealed. While all injuries cause veterans to ask themselves how their wounds will impact their lives, GU complications also often raise questions that are intertwined with deeply private and intimate areas, such as sexuality and reproductive health.

While we do not know what the TOUGH survey will reveal, we know it has incredible potential to improve the lives of veterans. Evidence-based data could open the door to new ways of preserving reproductive capabilities and GU function, more effective long-term care, increased mental health resources, and well-informed programs from veteran service organizations. Most importantly, this survey will be an important step toward providing these veterans the support and care they richly deserve and that our nation owes them.

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