Saving a soldier's life takes precedence over（优先于） treating traumatic urologic（泌尿道的） injuries on the battlefield, a Medical College of Georgia researcher says. Injuries to the bladder（膀胱） , ureters（输尿管） , kidneys and external genitalia（生殖器） often require complex surgical² treatment, said Dr. Arthur Smith, an MCG urologist. But during wartime, when those wounds are often combined with other life-threatening injuries, their treatment becomes secondary to lifesaving tactics.

Smith made his comments at a lecture, Revised Management Strategies for Urologic Injuries During Wartime, at the Warrior³ Health Symposium⁴ in Canberra, Australia Oct. 30. The symposium（讨论会，座谈会） is co-sponsored by the Australian Military Medical Association and the Australian Defense⁵ Force Joint⁶ Health Command.

"Most urological injuries occurring in the civilian⁷ setting result from blunt trauma¹, but they are far fewer in occurrence and their treatment is generally implemented⁸ in a straightforward⁹ way with an organized and well-supported health care system," he said. "During wartime, though, penetrating¹⁰ injuries are more common and rarely occur in isolation¹¹, because victims often receive multiple injuries concurrently¹²（同时发生地） . Treatment options must change and be prioritized."

Treating multiple injuries is only part of the problem.

"Other variables," Smith said, "commonly affect surgical intervention¹³: the status of resources, the number of other casualties and, of course, the overall tactical situation."

Advanced weapons such as improvised¹⁴ explosive devices and multiple fragmentation munitions¹⁵ that cause a wide spectrum¹⁶ of injuries also complicate¹⁷ matters, he added. Because treating urologic injuries is a lower priority, complications often arise. In some cases, injuries are discovered later or missed altogether.

"During wartime, casualties are all managed through echelons¹⁸（职位，阶层） of care," Smith said. "When someone is injured, he may be treated on the battlefield, at a field hospital, at an evacuation hospital and then transferred to a more permanent location."

All of those echelons require different treatment strategies, he explained. On the battlefield, treatment is most likely focused on stopping the bleeding; field hospital treatment may include early life-saving amputations（截肢）  at an evacuation hospital, there may be surgery to repair wounds – and urologic injuries, especially those to the kidneys and internal organs – may not be discovered until then.

"What we have to realize is that it's a very fluid situation often comprised of variable facilities, austere¹⁹（严峻的） conditions and limited logistics support and evacuation staff. We often have to treat with a damage-control mentality²⁰."