Tuesday, April 29, 2014

Historical Contribution: 1920, Colston, Gun Shot Wounds to the Urethra


Colston JAC.  Observations on Gun-Shot Wounds of the Urethra.  J of Urol.2;185-192.

John Archibald Campbell Colston, a John Hopkins urologist, served with the Allied Forces during WWI. Dr. Colston documented his entire experience in the "J.A.C. Colston WWI diaries," 1914-1915; and is considered a valuable first-hand look at the Great War from the prospective of a doctor who served.  In the above manuscript, published in the Journal of Urology after his return from the War, Dr. Colston describes his experience treating urethral injuries suffered during World War I.  He comments,
"Following an injury to the urethra there is usually obstruction to urination and often a rapid extravasation of urine.  On this account these cases urgently require immediate attention, but unfortunately, conditions on the field are such that is is rare for the wounded man to receive surgical intervention...  during which time the surrounding tissues, devitalized by the trauma of teh projectile and the increasing extravasation of urine, form a most favorable medium for the growth of microorganisms carried into the wound by the projectile." 
Therefore, very few of these wounds were seen in the hospital - as very few of these men made it off the battle field.  Of note, the three men presented in this report had soft tissue injuries to the lower extremities or scrotum, no intra-abdominal wounds.  From his experience and the experience of other genitourinary surgeons during the war, Colston draws the final recommendations for the management of urethral injury:
  1. Divert the urine by suprapubic cystotomy and widely open the injured area.
  2. Immediate suture should only be attempted after urinary diversion.
  3. Transfer patients to hospitals specializing in urologic surgery once they are stabilized.

Read the entire manuscript using the link above or here.

HISTORICAL CONTRIBUTIONS highlight the greatest academic manuscripts from the Brady Urological Institute over the past 100 years.  As the Brady Urological Institute approaches its centennial, we will present a HISTORICAL CONTRIBUTION from each of the past 100 years.  In the most recent experience, the most highly cited article from each year is selected; older manuscripts were selected based on their perceived impact on the field.  We hope you enjoy! 


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