Significant extraperitoneal bladder rupture with gross hematuria

Intraperitoneal bladder rupture

Significant extraperitoneal bladder rupture associated with pelvic fracture requiring treatment by external fixation

Significant extraperitoneal bladder rupture with extravasation of contrast agent into the scrotum

Significant extraperitoneal bladder rupture that has not healed after 3 weeks of Foley catheter drainage

None of the above

An absolute indication for immediate cystography is the presence of pelvic fracture and microhematuria.

If plain film cystograms are obtained, the study is considered negative and complete if there is no extravasation of contrast agent seen on the filling film.

If the patient is already undergoing computed tomography (CT) for evaluation of associated injuries, CT cystography should be performed via antegrade filling of the bladder after intravenous administration of radiographic contrast material and clamping the Foley catheter.

CT cystography is best performed with undiluted contrast medium.

They are present in 90% of patients presenting with pelvic fractures.

Extraperitoneal ruptures are always amenable to nonoperative treatment.

High mortality rate is primarily related to nonurologic comorbidities.

They coexist with urethral disruption in 50% of cases.

They are associated with microhematuria or no hematuria in 40% of cases.

associated urethral injury.

associated vaginal injury.

associated rectal injury.

associated orthopedic injury.

all of the above.

UroLume stent placement is recommended.

Orthopedic hardware in the pubic symphysis area is a contraindication to open posterior urethroplasty.

One-stage, open, perineal anastomotic urethroplasty is preferred.

Buccal mucosa graft urethroplasty is recommended.

The patient is at high risk for incontinence after posterior urethral reconstruction surgery.

CT of abdomen and pelvis

Bladder ultrasonography

Filiforms and followers

Retrograde urethrography

None of the above

Magnetic resonance imaging of the penis

Cavernosography

Exploration of the penile corpora through a midline scrotal incision

Exploration of the penile corpora through a circumcision incision

Ultrasonography of the penis

Application of wet dressings and delayed testicular surgery

Closure of the scrotal laceration followed by ultrasonography

Left orchiectomy

Left testicular reconstruction with synthetic graft

Immediate primary repair of the left testis

Perineal urethrostomy

Suprapubic tube placement

Urethral catheterization alone

Buccal mucosa graft urethroplasty

Spatulated, stented, tension-free, watertight repair of the urethra with absorbable sutures

Rupture of a superficial vein can sometimes mimic the presentation of a corporeal tear.

Most injuries occur ventrolaterally.

Patients with penile fracture who are treated nonoperatively are more likely to have longer hospital stays, a higher risk of infection, and penile curvature than those whose fracture is repaired surgically.

Retrograde urethrography should be uniformly performed to assess for urethral injury.

Physical examination is usually sufficient in making the diagnosis or for deciding on surgical exploration.

Spermatic cord

Dartos muscle

Tunica vaginalis

Tunica albuginea

Camper fascia

has a degree of hematoma that correlates with the extent of injury.

is definitively diagnosed during physical examination alone in most cases.

requires conservative management that results in acceptable viability and function.

is usually a bilateral process.

is often diagnosed by the presence of intratesticular hypoechoic areas on ultrasonography.

The severed phallus should be placed directly on ice during transport.

Skin loss is rarely a problem after macroscopic repair.

Microscopic reanastomosis of the corporeal arteries is recommended.

Microscopic dorsal vascular and neural reanastomosis is the best method of repair.

Primary macroscopic reanastomosis invariably results in erectile dysfunction.

Burying the penile shaft in a scrotal skin tunnel

Thigh flaps

Foreskin flap for small distal lesions

Meshed skin graft in a young child

Wet-to-dry dressings

all of the above.

inspection of bladder.

an opportunity for controlled antegrade urethral realignment.

allowance for large-bore catheter insertion.

not jeopardizing continence or potency rates.