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