Management of complex combat-related pelvic organ injuries: Case series and review of complications

Pelvic organ injuries in combat conditions are relatively uncommon but are associated with a high risk of complications, particularly urinary injuries combined with pelvic fractures, vascular trauma, and other abdominal injuries in the setting of polytrauma. The provision of effective medical care in modern conflicts is complicated by logistical constraints, including delayed evacuation, limited imaging capabilities, and shortages of specialized personnel. This study analyzes diagnosis, treatment, and complications of combat-related urinary injuries and identifies approaches to optimize medical care. A series of clinical cases was reviewed, including five patients treated at various stages of medical evacuation. Diagnostic strategies, surgical tactics, complications, and outcomes were evaluated. Challenges included delayed diagnosis, underestimation of injury severity, unjustified conservative management of intraperitoneal ruptures, technical shortcomings in bladder repair, and insufficient interdisciplinary coordination. Complications such as urinary extravasation, peritonitis, infection, and secondary fistula formation were observed. Favorable outcomes were associated with timely injury recognition, urgent surgical intervention, continuity of staged evacuation, and early involvement of urological expertise. Optimization of diagnostic and treatment pathways and strengthening multidisciplinary collaboration are essential to reduce morbidity in combat-related pelvic organ injury trauma.