Majority of Civilian Bladder Trauma in Iraq from Penetrating Injuries

Stephanie Doyle

May 22, 2008

May 22, 2008 (Orlando, Florida) — The most common causes of civilian bladder trauma in Iraq are penetrating injuries from bullets or metallic fragments created by improvised explosive devices (IEDs), according to physicians who shared their experiences here at the American Urological Association 2008 Annual Meeting.

Fighting in Iraq has produced many civilian casualties, meaning that doctors there are treating an unusually high proportion of civilian — as opposed to combatant — injuries. Two urologists from Al Yarmouk Teaching Hospital in Baghdad, one of Iraq's most well-known trauma centers, detailed their experiences in the management of bladder injury in civilians with major abdominal trauma.

From January 2005 to August 2006, the emergency department at Al Yarmouk Teaching Hospital received 533 patients with major abdominal trauma. Penetrating bladder injuries occurred in 12% of these cases.

"The civilians have no protection and they cannot predict when the violence will occur," Dr. Firas Petros told Medscape Urology. Petros, an Iraqi native and urology resident there, is now in Michigan preparing for his American medical licensing examination.

According to his study, the majority of the patients were injured by bullets (78.1%); the others were injured with shells or shrapnel from IEDs. Associated bowel injury was present in 89% of patients. The majority of injuries were severe and strongly associated with other organ injuries. When abdominal injury was associated with chest and/or vascular trauma, there was a significantly higher mortality rate.

In the United States, the most common cause of bladder trauma is blunt force, usually due to automobile accidents.

Ira D. Sharlip, MD, clinical professor of urology at the University of California, San Francisco, who was not involved in the study, explained that different wars in history have produced unique types of trauma.

"This is a unique medical experience during wartime because such a large number of civilian injuries have been treated," said Dr. Sharlip, who visited Al Yarmouk Teaching Hospital 4 years ago. "They did a remarkable job of managing the injuries with limited resources."

Dr. Petros said imaging at Al Yarmouk was limited to the "ordinary x-ray."

Despite finding that 54.7% of the abdominal injuries were stage 4 (advanced in the staging system of the American Association for the Surgery of Trauma), serious long-term complications occurred in only 10.9% of cases. The majority (76.6%) were discharged alive and almost all of the bladder-trauma cases recovered normal bladder function.

The researchers have disclosed no relevant financial relationships.

American Urological Association (AUA) 2008 Annual Meeting: Abstract 62. Presented May 17, 2008.


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