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Army veteran, UTSW surgeon helps fellow vets deal with sensitive combat wounds

TOUGH survey addresses long-term impact of genitourinary injuries

Many U.S. service members struck by ground explosives during the conflicts in Iraq and Afghanistan suffered genitourinary (GU) injuries to their urinary, genital, and reproductive systems. Photo credit: Getty Images

DALLAS – Nov. 08, 2022 – Combat wounds to a soldier’s genital area are not as well understood as those to other parts of the body because of the intimate nature of the injuries. A new survey, co-led by Steven J. Hudak, M.D., Associate Professor of Urology at UT Southwestern and a former U.S. Army officer, aims to shed light on these injuries and improve treatment.

Steven J. Hudak, M.D.

Over the past two decades, unprecedented numbers of service members were hit by ground explosives during the conflicts in Iraq and Afghanistan, causing severe injuries. In addition to losing limbs, these troops often suffered genitourinary (GU) injuries to their urinary, genital, and reproductive systems.

Understanding the long-term impact of these injuries, including the effects on sexual and reproductive abilities and mental health, is essential to providing the best possible care, said Dr. Hudak, a former Army surgeon who has cared for many service members who suffered GU injuries. He also provides reconstructive genitourinary surgery at UT Southwestern, which is ranked No. 11 in the nation for urology care by U.S. News & World Report.

Dr. Hudak was part of the team that designed and carried out the initial phase of the TOUGH (Trauma Outcomes and Urogenital Health Project) survey, which identified nearly 1,500 male service members who sustained GU injuries in Iraq and Afghanistan. The survey, which has the support of the Department of Defense, categorized the types and severity of the injuries.

“In 2010, there was a troop surge in Afghanistan, and we started seeing a level of GU injury that we had never seen. That’s when we realized this was research that needed to be done,” said Dr. Hudak.

The results of the initial TOUGH survey were published in 2017. Phase 2 of the survey, which will look at the long-term impact of these injuries, opened in September.

“Phase 1 was backward-looking. Most of these men were in their 20s. Many had not yet had children,” said Dr. Hudak. “The new study attempts to identify what life is like for these individuals years down the road after their injury. What care gaps exist?”

The principal categories of health-related effects for GU injuries are sexual, urinary, and reproductive function. But the survey also will study how these injuries affect mental health, intimate-partner relationships, and overall quality of life.

The survey’s goal is to guide improvements in the area of GU injuries, such as protective wear to reduce the severity of injuries, the banking of sperm before service members go into combat, improved surgical techniques, and more widely available couples counseling services.

“This survey will be an important step toward providing these veterans the support and care they richly deserve and that our nation owes them,” Dr. Hudak said.

The survey takes about an hour to complete and can be found at

About UT Southwestern Medical Center

UT Southwestern, one of the nation’s premier academic medical centers, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty has received six Nobel Prizes, and includes 24 members of the National Academy of Sciences, 18 members of the National Academy of Medicine, and 14 Howard Hughes Medical Institute Investigators. The full-time faculty of more than 2,900 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide care in more than 80 specialties to more than 100,000 hospitalized patients, more than 360,000 emergency room cases, and oversee nearly 4 million outpatient visits a year.