Urotrauma bill may have platform for passage

Washington-A national crisis over huge Veterans Administration backlogs in providing medical benefits to soldiers returning from Afghanistan and Iraq may be providing the platform for congressional consideration of legislation aimed at addressing urotrauma injuries incurred in combat.

As a result of a determined initiative by the AUA, a new amendment was added to the 2014 National Defense Authorization Act (NDAA) calling for the development and implementation of a comprehensive policy on improvements to the care, management, and transition of recovering service members with urotrauma. The NDAA passed the House of Representatives June 14 and was sent to the Senate.

The amendment calls for the Departments of Defense (DoD) and Veterans Affairs to jointly develop the policy. It was introduced by Rep. Brett Guthrie (R-KY), the lead sponsor of H.R. 984, a bill that would establish a federal task force on urotrauma.

The AUA has been working on the issue since 2009, and on May 21 Mark Edney, MD, a Salisbury, MD urologist and veteran of Operation Iraqi Freedom, testified before the House Veterans Affairs Subcommittee on Health urging approval of H.R. 984.

Urotrauma a ‘significant issue’

As Dr. Edney told the subcommittee, urotrauma is a significant issue for active military populations, particularly those who have served in Iraq and Afghanistan. Improvised explosive devices (IEDs), when detonated, can cause severe trauma to the sexual organs and genitourinary system, which can have a devastating impact on urinary and sexual function and fertility. In Afghanistan, many soldiers are required to patrol on foot and are especially vulnerable to IEDs.

Dr. Edney’s testimony was part of a hearing that focused on the failure of the VA to provide timely care for returning veterans, including mental health care. Reported suicides by returning veterans have highlighted the issue.

“Although each of the functional challenges that result from damage to the genitourinary organs is life altering, perhaps one of the most profound is loss of fertility,” Dr. Edney said. “The brave young Americans who are voluntarily putting themselves in harm’s way in defense of our country are often doing so prior to their reproductive years. Some are suffering injuries that severely impair or eliminate their natural reproductive capability, shattering a dream of many-to begin a family of their own.”

Bill calls for comprehensive study

H.R. 984 calls for establishment of an interagency task force, led by the Department of Defense (DoD), to investigate and advise on the research and action needed to address urotrauma. The task force would conduct a comprehensive study of the present state of knowledge and research on urotrauma, evaluate existing education and research resources, and identify knowledge and programmatic gaps.

That study would analyze urotrauma among members of the Armed Forces and veterans, including an analysis of the incidence, duration, morbidity rate, and mortality rate of urotrauma; an analysis of the social and economic costs; and an evaluation of facilities and access to private facilities and resources, research activities, and programs that improve the prevention or treatment of urotrauma.

It would also provide for development of a long-range plan, based on the study, for the use and organization of national resources to effectively deal with urotrauma, including researching innovations in the care and treatment of persons affected; identifying ways to prevent or minimize such injuries; and improving education and training for medical personnel caring for these individuals and to the general public.

Dr. Edney pointed out that the bill seeks an analysis of technical, administrative, and budgetary mechanisms to allow for enhanced reproductive services for members who have been affected by urotrauma or who are at high risk of urotrauma.

While there are at least two DoD databases that collect information on urotrauma injuries for follow-up and research, and more than 16,000 battlefield traumas have been catalogued since 2003, details are insufficient to allow the longitudinal follow-up and outcomes research that are needed, he said.

‘Much to be done’ on issue

“The AUA recognizes that there’s much to be done in this area, from pre-deployment sperm banking, to cryopreservation of sperm at the initial point of care when testicular loss is inevitable, to providing advanced reproductive services to all military urotrauma victims who are infertile and receiving care in the DoD and VA,” he told lawmakers.

“Genitourinary injuries are an increasingly common, complex constellation of wounds with devastating long-term implications for urinary, bowel, and sexual function, and fertility. These sequelae in turn have profound impact on soldiers’ mental health, marriages, other social relationships, and overall quality of life,” he added.

The bill, he said, provides the “comprehensive study required to address the variety of opportunities for improving the prevention, initial management, care coordination, and research of this devastating and increasingly prevalent pattern of injury. We owe these finest of Americans no less for the sacrifices they have made for our great nation.”

Dr. Edney said the AUA has been advised by urologists in both the DoD and VA that soldiers’ records often are not being effectively transferred from the DoD to the VA when service members return home.

“There are opportunities to improve and standardize communication between DoD and VA physicians,” he said.

The AUA’s effort on urotrama was launched in 2009 when it convened a working group comprised of AUA members within the DoD together with civilian trauma and genitourinary reconstruction experts to formulate policy, craft legislation, and develop a comprehensive legislative strategy, Dr. Edney told the subcommittee. The broad goals of the working group were to improve the prevention of, improve and educate regarding the initial management of, and better coordinate the chronic care of urotrauma, and to enhance urotrauma’s research infrastructure to facilitate outcomes research and longitudinal follow-up of urotrauma cases.UT