Significant extraperitoneal bladder rupture with gross hematuria
Intraperitoneal bladder rupture
Significant extraperitoneal bladder rupture that has not healed after 3 weeks of Foley catheter drainage
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
None of the above
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.
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.
An absolute indication for immediate cystography is the presence of pelvic fracture and microhematuria.
They are associated with microhematuria or no hematuria in 40% of cases.
Extraperitoneal ruptures are always amenable to nonoperative treatment.
They are present in 90% of patients presenting with pelvic fractures.
They coexist with urethral disruption in 50% of cases.
High mortality rate is primarily related to nonurologic comorbidities.
associated urethral injury.
associated orthopedic injury.
all of the above.
associated rectal injury.
associated vaginal injury.
Orthopedic hardware in the pubic symphysis area is a contraindication to open posterior urethroplasty.
The patient is at high risk for incontinence after posterior urethral reconstruction surgery.
One-stage, open, perineal anastomotic urethroplasty is preferred.
UroLume stent placement is recommended.
Buccal mucosa graft urethroplasty is recommended.
CT of abdomen and pelvis
Filiforms and followers
None of the above
Magnetic resonance imaging of the penis
Exploration of the penile corpora through a midline scrotal incision
Exploration of the penile corpora through a circumcision incision
Ultrasonography of the penis
Left testicular reconstruction with synthetic graft
Immediate primary repair of the left testis
Application of wet dressings and delayed testicular surgery
Closure of the scrotal laceration followed by ultrasonography
Suprapubic tube placement
Urethral catheterization alone
Spatulated, stented, tension-free, watertight repair of the urethra with absorbable sutures
Buccal mucosa graft urethroplasty
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.
Physical examination is usually sufficient in making the diagnosis or for deciding on surgical exploration.
Rupture of a superficial vein can sometimes mimic the presentation of a corporeal tear.
Retrograde urethrography should be uniformly performed to assess for urethral injury.
is definitively diagnosed during physical examination alone in most cases.
requires conservative management that results in acceptable viability and function.
is often diagnosed by the presence of intratesticular hypoechoic areas on ultrasonography.
is usually a bilateral process.
has a degree of hematoma that correlates with the extent of injury.
Skin loss is rarely a problem after macroscopic repair.
Microscopic dorsal vascular and neural reanastomosis is the best method of repair.
Microscopic reanastomosis of the corporeal arteries is recommended.
Primary macroscopic reanastomosis invariably results in erectile dysfunction.
The severed phallus should be placed directly on ice during transport.
Foreskin flap for small distal lesions
Burying the penile shaft in a scrotal skin tunnel
Meshed skin graft in a young child
allowance for large-bore catheter insertion.
inspection of bladder.
an opportunity for controlled antegrade urethral realignment.
not jeopardizing continence or potency rates.
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