Genitourinary outcomes were not addressed separately in Volume 4 of the Gulf War and Health series. Major conditions in this group include kidney disease, urolithiasis (“kidney stones”), urinary tract infections, prostatitis, and sexual difficulties. Gynecologic outcomes including abnormal cervical pathology and inflammatory disease of the ovary have also been assessed in studies of Gulf War veterans and are discussed in this section. Cancers of the genitourinary system such as testicular cancer are not addressed in this section, but are discussed in the section on cancer. Table 4-13 summarizes the findings of primary studies of genitourinary system diseases.

Genitourinary Outcomes

Updated and Supplemental Literature
Primary Studies

Frommelt et al. (2000) used existing clinical records on Papanicolaou (Pap) smears to assess differences in cervical pathology among female Gulf War veterans. The authors evaluated Pap smear results from a cohort of 6715 Air Force women who served on active duty between August 7, 1990, and March 1, 1991, and had routine Pap smears conducted in 1994. A subset also had Pap smear data available for 1995 and/or 1996. Pap smear test results evaluated by the Armed Forces Institute of Pathology, which is the cytology laboratory used by 28 military treatment facilities, were collected for 1446 female Gulf War veterans and 5269 female veterans who were not deployed to the gulf. Overall, there were no observed differences in cervical pathology between the two groups. Among veterans aged 26-30 years, a diagnosis of “other than within normal limits” occurred more frequently among Gulf War veterans (11.5%) compared to nondeployed veterans (6.6%) (p = 0.013) in 1994, but no differences were detected among other age groups ranging from 20 and younger to over 50 years of age. The data were too sparse in 1995 and 1996 to conduct age-stratified analyses. The authors suggest there is no biologically plausible evidence to support an age-specific association between Gulf War service and abnormal cervical cytology.

McDiarmid and colleagues have followed a small cohort of 77 survivors of friendly-fire accidents who were exposed to depleted uranium (DU). The researchers conducted biennial clinical exams for uranium-related health effects. Clinical assessments included numerous urinary and serum markers of renal function as well as semen analyses and neuroendocrine measures as indicators of reproductive health (McDiarmid et al., 2000, 2001, 2004, 2006, 2007a,b, 2009). Over the 16 years of follow-up, biomarkers of renal function have not differed meaningfully (statistically or clinically) between those with low (< 0.1 microgram U/g creatinine) and high (≥ 0.1 microgram U/g creatinine) DU exposure. Similarly, no adverse DU effects on semen parameters or serum concentrations of testosterone, leutinizing hormone, or follicle-stimulating hormone have been observed. The comparisons, however, were based on small numbers (n = 35 for the 2007 exam) and did not control for potential confounders.

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