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
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
inspection of bladder.
an opportunity for controlled antegrade urethral realignment.
allowance for large-bore catheter insertion.
not jeopardizing continence or potency rates.
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