ORLANDO—Penetrating injuries from bullets or metal fragments from explosive devices are the most common cause of civilian bladder trauma in Iraq, according to Firas Ghanim Petros, MD, and his colleagues at Al Yarmouk Teaching Hospital, a major trauma center in Baghdad.


In an overview of their experience treating penetrating bladder injuries in abdominal trauma, Dr. Petros noted that the incidences of bladder injury in the published literature from different wars have ranged from 15%-17% of the urologically injured populations studied in Vietnam, Croatia, and the first Gulf War. He reported findings here at the American Urological Association (AUA) annual meeting.

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From January 2005 to August 2006, the hospital’s emergency department received 533 patients with major abdominal trauma. Penetrating bladder injuries occurred in 12% of these cases. Most injuries resulted from bullets (78%); others were caused by shells or shrapnel from improvised explosive devices.


Associated bowel injury was present in the great majority of patients (89%). When abdominal injury was associated with chest or vascular trauma, the mortality rate was much higher.


Despite finding that 54.7% of the abdominal injures were stage IV (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. In addition, 76.6% of patients were discharged alive and almost all who suffered bladder trauma recovered normal bladder function.


“Different wars in history have produced unique types of trauma,” said Ira Sharlip, MD, a spokesman for the AUA. “The wartime medical experience in Iraq is unusual in having created such a large number of civilian injuries for civilian doctors to treat with limited facilities and equipment.”


“It is remarkable how well these horrendous injuries were treated using the very basic surgical therapy and basic equipment,” Dr. Sharlip said. “They are doing a fantastic job there with very limited equipment and facilities.”