Trauma Outcomes & Urogenital health Project

The Trauma Outcomes and Urogenital Health (TOUGH) Project is a Congressionally Directed Medical Research Program (CDMRP) funded research study. The goal of the research is to find out what happens to service members who had an injury to the genital or urinary areas of their bodies during Operation Iraqi Freedom or Operation Enduring Freedom (OIF or OEF). We call these Genitourinary (GU) injuries. We want to know how well individuals have recovered and if they are receiving the care they need for their injuries, understand what life is like after a GU injury, and how to improve medical care for these individuals.

What is a GU injury?

Genitourinary trauma is defined as a traumatic injury involving any organ or structure within the genital, urinary, and/or reproductive tract.

If you are a member of this group, please help us learn more about your experience by taking our survey so that we can better understand and treat these injuries.


Your Health, Our Priority

As researchers, it is our priority to advance the health and well-being of active-duty military, Veterans, and civilian families. Through research and active support from participants, we aim to improve future clinical impact and health outcomes.

A Message from the TOUGH Team

Patient surveys give us critical insight into the long-term outcomes of injuries that we simply cannot get by other means. While on active duty, I cared for a large number of service members who sustained GU injuries. They are proud Americans who have gone and continue to go above and beyond for their nation, and I encourage them all to contribute once more by taking this survey. Every entry will make a difference!

Dr. Steven J. Hudak, M.D.

Associate Investigator, UT Southwestern Medical Center and UT Health San Antonio



This research project is led by military surgeons who want to improve the medical care given to injured troops. Care for returning service members is, and will be, a lasting duty that is entrusted to all healthcare providers in the Departments of Defense and Veterans Affairs.

Why Take the Survey?

Our goal is to identify service members with GU injuries and ask them about their health status and health care needs, ensuring service members have received and are receiving proper care.

Our Survey aims to answer these questions:


What has been the lasting impact of GU Injuries for Service Members?


After initial treatment in theater, have service members required further care?


If so, have their medical needs been met?


Could we better protect, treat, and care for future service members who sustain these injuries?

About the Survey

 You are invited to participate in our survey of OEF/OIF service members who sustained genitourinary (GU) injuries. The survey is a series of questions about medical care received, the natural history of recovery, the long-term effects of injury, and quality of life.


Strictly Confidential

Survey responses will be reported as a collection of data, remaining completely confidential.

Data Driven to improve outcomes

Through research and active support from participants, we aim to improve future clinical impact and health outcomes.


Completely Voluntary

There are no foreseeable risks associated with this project. However, you may skip any question you feel uncomfortable answering or withdraw from the survey at any time. Withdrawal from the survey will not affect your healthcare or benefits.

If you have questions at any time about the survey or the procedures, you may contact the PI and/or research staff at or use the contact form below.

How Long Does it Take?

Less than one hour of your time can go a long way toward improving treatment for GU injuries.

Less than One Hour to Complete

Frequently Asked Questions

What is the TOUGH Project?

The Trauma Outcomes & Urogenital Health (TOUGH) project is a research project studying the long-term health and well-being of service members/veterans who sustained genitourinary (GU) injuries while deployed to Iraq or Afghanistan.

What is a GU injury?

Genitourinary (GU) injuries are trauma to the genital, urinary, or reproductive organs and structures. In many cases, these injuries were caused by improvised explosive devices (IEDs), which frequently caused limb amputations, traumatic brain injury, burns, sexual problems, infertility, and urinary symptoms.

How common are GU injuries among service members?

Historically, genitourinary (GU) injuries during combat have been rare. During the wars in Iraq and Afghanistan, rates of GU injury increased, likely due to the more widespread use of improvised explosive devices (IEDs). Advancements in battlefield medicine have decreased the number of deaths due to injury, also leading to an increased number of survivors of GU injuries. Previous generations of those injured in combat were much less likely to survive these patterns of injury.

Why is this study important?

The study will allow us to understand how to better protect, treat, and support future service members with genitourinary (GU) injuries. Specifically, the study seeks to determine (1) how well individuals have recovered, (2) if they are getting the care they need for their injuries, (3) what life is like after a GU injury, and (4) how to improve medical care for these injuries.

Who can participate?

Service members/veterans with genitourinary (GU) injuries that occurred during Operation Iraqi Freedom or Operation Enduring Freedom.

Letters describing the survey will be sent to qualifying service members/veterans with updated contact information on file with the Department of Defense. However, any service member who has sustained these injuries is strongly encouraged to participate in the survey, regardless of receiving a letter.

May I Have Assistance Filling Out the Survey if Necessary?

Yes. A veteran may receive assistance from a caregiver although we ask that the caregiver record the veteran’s answers and not independently respond to the survey. 

Where do you find the survey?
How long does the survey take?

The survey usually takes less than one hour.

Who is conducting the research?

The research is being conducted by a team from the University of Texas Health Science Center at San Antonio, University of California Davis, and Brooke Army Medical Center. Funding for the project was granted by the U.S. Army Medical Research Acquisition Activity (USAMRAA).

Will I be Able to Learn about the Survey Results and Potential Action?

Survey participants can expect to be updated about the progress of the research and receive action updates. To stay in touch, follow our website or contact us by e-mail,

Have more questions?

Email or use the contact form below. 

Get in Touch

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