War-related urological trauma in Israel: a retrospective national registry analysis.

Abstract

Background: Urological trauma significantly affects patient morbidity, functional outcomes, and healthcare resource utilization. This study evaluated war-related genitourinary (GU) injuries that occurred during the Israeli-Gaza War, with a focus on injury patterns, management, and clinical outcomes.

Methods: We conducted a retrospective analysis utilizing the Israeli National Trauma Registry, which is managed by the Gertner Institute for Health Policy and Epidemiology. This registry captures data on all of the patients admitted to trauma centers in Israel. Data quality is maintained through ongoing training of data abstractors and regular audits of registry data. All documented hospitalizations from October 7, 2023, to May 31, 2024, were included, excluding noncombat-related injuries. GU injuries were classified by anatomical location into the upper urinary tract (kidney/ureter), lower urinary tract (bladder/urethra), and external genitalia (penis/scrotum/testes). The data collected included demographics, injury mechanisms, injury severity score (ISS), surgical management, and clinical outcomes (ICU admissions, hospital length of stay [LOS], rehabilitation needs, and mortality). GU patients were compared with non-GU patients.

Results: Of the 2,422 total casualties, 117 (4.8%) sustained GU injuries. The mean age was 27.2 ± 9.2 years (range 14-76) in the GU-injured casualty group versus 30.1 ± 15.1 years (range 0-97) in the non-GU casualty group; the difference was not significant (p = 0.43), with 97.4% males. Explosive devices (59.0%) and gunshot wounds (36.8%) were the predominant injury mechanisms. Severe injuries (ISS ≥ 16) occurred significantly more frequently among GU-injured patients (61.5% vs. 21.6%, p < 0.0001). External genital injuries were the most common injuries (60.7%), followed by kidney (27.4%) and bladder damage (10.3%). Associated pelvic fractures occurred in 18% of the GU trauma patients versus 1.8% of the non-GU-injured patients (p < 0.0001). Surgical interventions were performed in 84.6% of the patients, among whom scrotal/testicular surgeries (27.4%) were most common. ICU admissions (44.4%), prolonged hospitalizations ≥ 14 days (41.4%), rehabilitation needs (53.0%), and mortality (6.8%) were significantly greater among GU-injured patients.

Conclusions: War-related GU trauma, although relatively uncommon, involves severe injuries, extensive surgical management, prolonged hospitalizations, and substantial rehabilitation demands. Enhancements in protective equipment and multidisciplinary treatment strategies are critical for optimizing outcomes in future conflicts.