Genitourinary trauma and priapism

• Genitourinary injury is usually part of polytrauma: secure the airway, breathing and circulation first, then stage each organ injury and control bleeding.
• Renal trauma occurs in up to 5% of all trauma cases and about 4.9 per 100,000 population; most grade 1 to 4 renal injuries are now managed without operation, with selective angioembolisation for active bleeding. ^[1]
• Haematuria may be absent in major renal, ureteric and PFUI injuries; mechanism and imaging matter more than the colour of the urine. ^[1]
• Bladder rupture is intraperitoneal (usually the dome) or extraperitoneal (usually with pelvic fracture); cystography distinguishes them, and intraperitoneal rupture must be repaired surgically. ^[1]
• Penile fracture, testicular rupture, PFUI and ischaemic priapism are urological emergencies: repair penile and testicular injuries promptly, and resolve ischaemic priapism within 4 hours to protect erectile tissue. ^[1][2]

By the end of this page you should be able to:

1. Recognise the presentations that suggest injury to the kidney, ureter, bladder, urethra, penis or scrotum after trauma. ^[1]
2. Explain why haemodynamic stability and not anatomy alone decides operative versus non-operative care in renal trauma. ^[1]
3. Differentiate intraperitoneal from extraperitoneal bladder rupture on imaging and manage each. ^[1]
4. Perform and interpret a retrograde urethrogram and outline management of posterior and anterior urethral injury. ^[1]
5. Recognise penile fracture, testicular rupture and ischaemic priapism and arrange the correct first steps quickly. ^[1][2]
6. Describe the bedside management of ischaemic priapism, including aspiration, irrigation and intracavernosal phenylephrine. ^[2]

Genitourinary trauma is injury to the kidneys, ureters, bladder, urethra or external genitalia from blunt, penetrating, iatrogenic or, rarely, sexual mechanisms. These organs are relatively well protected, so an isolated genitourinary injury is uncommon, but these injuries matter because urinary and sexual function can be lost if the assessment is rushed or the urethra is instrumented blind. In polytrauma the genitourinary injury is almost never the first priority: airway, breathing, massive haemorrhage, head and chest injury and pelvic instability come first. Damage-control principles therefore apply, and complex reconstruction is deferred until the patient is warm, coagulated and perfused. ^[1]

This presentation follows the 2026 edition of the European Association of Urology (EAU) Guidelines on Urological Trauma, which is the newest open-access edition available, together with an open review of ischaemic priapism management that draws on the Acute Ischemic Priapism guideline of the American Urological Association and the Sexual Medicine Society of North America (AUA/SMSNA, 2021) and the recurrent ischaemic priapism guideline (AUA/SMSNA, 2022). ^[1][2][3] Where sources differ, both positions are given.

Causes group naturally by organ and by how quickly they threaten life or function.

• Kidneys. Blunt trauma from road traffic accidents, falls, sporting injuries and assault; rapid deceleration can avulse the vascular pedicle or the ureteropelvic junction. Penetrating stab and gunshot wounds, more common in urban settings, tend to be less predictable. Pre-existing hydronephrosis, a solitary kidney or stone disease increases the chance of injury. ^[1]
• Ureters. Most injuries are iatrogenic, during gynaecological, colorectal or urological surgery, with risk rising when anatomy is altered by prior surgery, inflammation, malignancy, endometriosis or retroperitoneal fibrosis. External trauma comes from penetrating abdominal injury or deceleration. Ureteric trauma accounts for 1 to 2.5% of urinary tract trauma. ^[1]
• Bladder. Blunt injury from road traffic accidents, falls and blows to the lower abdomen; 60 to 90% of blunt bladder injuries have an associated pelvic fracture, but bladder injury complicates only about 3% of pelvic fractures and up to 26.5% of severe pelvic disruption. Alcohol intoxication increases risk. Iatrogenic injury mainly occurs during gynaecological, urological and general surgery. Bladder injury is associated with urethral injury in 5 to 20% of cases. ^[1]
• Urethra. Posterior injuries are pelvic fracture urethral injuries (PFUI), from motor vehicle crashes (68 to 84%) or falls from height (6 to 25%). Anterior injuries are usually straddle injuries to the bulbar urethra, or penetrating trauma. Catheterisation injures the urethra in 6.2 to 13.4 per 1,000 catheters. PFUI occurs in up to 25% of male pelvic fractures. ^[1]
• External genitalia. Sports, cycling, assault, and sexual accidents including penile fracture. Blunt genital trauma is about 80% of genital injuries; 33 to 66% of all urological injuries involve the external genitalia, and blunt genital injuries are often unilateral (about 1% bilateral) whereas penetrating scrotal injuries involve both testes in about 30%. ^[1]
• Priapism. Ischaemic (low-flow) priapism is a painful rigid erection beyond sexual stimulation, usually a veno-occlusive event. Recognised triggers include sickle cell disease and other haematological dyscrasias, leukaemia, drugs such as antipsychotics and intracavernosal agents, prolonged immobilisation, spinal cord lesions, and idiopathic cases. Non-ischaemic (high-flow) priapism follows perineal or penile trauma with an arterial fistula and is usually less painful and less urgent. ^[2][3]

Urgency. Threats to life come first: unstable renal haemorrhage, an expanding perirenal haematoma and massive pelvic bleeding. Threats to function come next: PFUI, penile fracture, testicular rupture, intraperitoneal bladder rupture, and ischaemic priapism beyond 4 hours. Stable collecting-system injury, uncomplicated extraperitoneal bladder rupture and small scrotal haematoceles can be assessed before definitive plans are made. ^[1][2]

• Unstable renal or pelvic bleeding. A lack of response, or only a transient response, to resuscitation predicts nephrectomy; blood lactate at least 4 mmol/L is a marker of this risk. ^[1]
• Expanding or pulsatile perirenal haematoma at laparotomy, or haemodynamically unstable grade 5 vascular renal injury. ^[1]
• Blood at the urethral meatus or a distended bladder after pelvic fracture: suspect PFUI, and never pass a urethral catheter blindly against resistance. ^[1]
• Penetrating genital or pelvic wounds and iatrogenic bladder injury with signs of peritonitis, fever or ileus. ^[1]
• Priapism longer than 4 hours with a rigid, painful penis: this is a urological emergency and should be treated as a compartment syndrome. ^[2][3]
• Dark aspirate on corporal blood gas, with pO2 under 30 mmHg, pCO2 over 60 mmHg and pH under 7.25, confirms ischaemic priapism. ^[2]

Mechanism. Ask for the force, direction and velocity of the event. A rapid deceleration, fall from height or high-speed road traffic accident raises concern for renal pedicle or ureteropelvic junction avulsion, pelvic ring disruption, and PFUI. ^[1]

Pelvic fracture. A pelvic fracture makes bladder and urethral injury likely enough to image them routinely, especially with gross haematuria or a high-risk pelvic disruption (displacement over 1 cm or pubic symphysis diastasis over 1 cm). ^[1]

Voiding. The cardinal early signs are gross haematuria, inability to void, a palpable distended bladder, and urine leaking from a drain or wound. Ask about the timing: iatrogenic ureteric injury (the commonest cause) often presents days later with fever, flank pain, ileus or urea elevation. ^[1]

Catheter history. A recent urethral catheter, cystoscopy or endoscopic procedure can injure the urethra and bladder. ^[1]

Sexual history and baseline function. Before priapism or genital trauma, ask about baseline erectile function and medications. In priapism, precipitants such as intracavernosal injections, oral erectile agents, antipsychotics, alpha-blockers, testosterone supplements, alcohol and recreational drugs are all relevant. ^[2][3]

Haematology and risk. In a young patient with priapism or recurrent episodes, ask about sickle cell disease, other haematological disease and malignancy, because these change both diagnosis and prevention. ^[2][3]

Time. For priapism, minute-level timing is management rather than history: ischaemic priapism lasting under 24 hours is "acute", and lasting 24 hours or more is "prolonged", with a sharply rising risk of erectile dysfunction. ^[2][3]

Resuscitation first. Record vital signs throughout: they give the most reliable indication of urgency. ^[1]

• Abdomen and flanks. Look for flank mass or bruising, rib fractures, abdominal distension, tenderness and entry or exit wounds. ^[1]
• Genital and penile. Assess whether the penis is rigid, swollen or deviated, whether the glans is involved (spongiosum), and for a palpable defect in a fractured tunica. ^[1][3]
• Scrotum. Tender, swollen, ecchymotic hemiscrotum with a testis that is hard to feel suggests testicular rupture. ^[1]
• Perineum. Ecchymosis, swelling and blood at the meatus suggest urethral rupture. ^[1]
• Rectal examination. Mandatory in PFUI to exclude associated rectal injury (up to 5%); a "high-riding prostate" may be found but is unreliable. ^[1]
• Females. PFUI is rare and devastating; examination should be supported by cystourethroscopy and vaginoscopy rather than urethrography. ^[1]
• Priapism. In ischaemic priapism the corpora cavernosa are engorged, fully rigid and painful; the glans and spongiosum are usually spared until infarction. High-flow priapism is tumescent rather than rigid and is not painful. ^[2][3]
• Doppler. Colour duplex ultrasound helps distinguish ischaemic from non-ischaemic priapism: ischaemic flow is high resistance and low velocity, while non-ischaemic flow is high and variable, with peak systolic velocities around 30 to 40 cm/s in tumescence. ^[2][3]

Renal. A trauma-protocol computed tomography (CT) scan is the imaging modality of choice: it grades the injury, confirms the contralateral kidney and shows associated injuries. The ideal renal protocol is three-phase, arterial, nephrographic and delayed, with delayed imaging at about 5 minutes; the delayed phase may be unreliable in hypovolaemic patients and is often omitted from whole-body trauma protocols. ^[1]

Imaging is indicated by visible haematuria, non-visible haematuria with an episode of hypotension, rapid deceleration with significant associated injuries, penetrating trauma, or clinical signs suggesting renal trauma such as flank pain, abrasions, fractured ribs, abdominal distension or a mass. ^[1]

Bladder. Cystography (plain or CT) is the diagnostic test, with comparable sensitivity of 90 to 95% and specificity of 100%. It must use retrograde filling with at least 300 to 350 mL of dilute contrast; passive filling by clamping a catheter during the excretory phase is insufficient. CT cystography is preferred when bone fragments, bladder neck or other abdominal injuries must be assessed. Absolute indications for imaging are visible haematuria with a pelvic fracture, or non-visible haematuria with a high-risk pelvic fracture or posterior urethral injury. ^[1]

Urethra. Retrograde urethrography (RUG) is the standard early test in males. Inject 20 to 30 mL of contrast while occluding the meatus, with images at 30 degrees oblique (in PFUI the X-ray beam is tilted). Any extravasation is pathognomonic of injury, and RUG reliably locates anterior versus posterior injury, but it cannot reliably distinguish partial from complete rupture; a combined RUG plus antegrade cystourethrogram is used before deferred repair. RUG should be postponed in unstable patients. Flexible cystourethroscopy is an alternative. In females, urethrography is impractical and cystourethroscopy plus vaginoscopy are preferred. ^[1]

Ureter. CT urography is the examination of choice; extravasation in the delayed phase is the hallmark, although hydronephrosis, ascites, urinoma or mild ureteric dilatation may be the only signs. In unclear cases, retrograde or antegrade urography is the best confirmation. One-shot intravenous pyelography is negative in up to 60% of patients. ^[1]

Genital imaging. Ultrasound is the recommended imaging for scrotal trauma and may show heterogeneous echotexture with loss of contour in testicular rupture, though sensitivity is reported as low (28 to 78% specificity) when separating rupture from haematocele; colour Doppler helps assess perfusion. For penile fracture, diagnosis is clinical, with ultrasound, cavernosography or contrast-enhanced MRI reserved for equivocal cases; MRI is superior to ultrasound for tunica laceration. ^[1]

Priapism. Aspirated corporal blood is dark in ischaemic priapism, with pO2 under 30 mmHg, pCO2 over 60 mmHg and pH under 7.25; non-ischaemic blood is bright red. Laboratory work-up for suspected stuttering or ischaemic priapism includes complete blood count, coagulation and metabolic screening, sickle cell testing when prevalence supports it, toxicology, and prostate and endocrine assessment where relevant. ^[2][3]

The presentation reduces to a short algorithm: stabilise, then determine whether the injury is life-threatening, function-threatening or stable, and image before intervention.

Renal trauma. Haemodynamic stability is the primary criterion. Grades 1 to 3 are managed non-operatively with bed rest, serial blood tests and regular observation; grade 4 is also mostly treated conservatively but with more later intervention. Persistent urinary extravasation from a viable blunt injury usually responds to ureteric stent placement and percutaneous drainage. Over half of grade 5 injuries confirmed on CT can be managed non-operatively in selected stable patients with lower transfusion requirements and less severe radiological injury. Unilateral main arterial injury or arterial thrombosis is managed non-operatively in stable patients; surgical repair is reserved for bilateral injury or injury to a solitary functioning kidney. ^[1]

Selective angioembolisation protects renal function and reduces nephrectomy in high-grade blunt and penetrating injury; active extravasation, arteriovenous fistula or pseudoaneurysm indicate it, and active extravasation with a perirenal haematoma deeper than 25 mm predicts need well. Repeat embolisation prevents nephrectomy in 67% of patients, and open surgery after failed embolisation usually results in nephrectomy. Non-operative management with SAE is successful in up to 94.9% of grade 3, 89% of grade 4 and 76% of grade 5 blunt injuries. Penetrating injuries are successfully managed non-operatively in up to 50% of stab wounds and up to 40% of gunshot wounds in selected stable patients. ^[1]

Indications for exploration include lack of, or only transient, response to resuscitation with blood lactate at least 4 mmol/L, concomitant injury requiring laparotomy, an expanding or pulsatile perirenal haematoma, haemodynamically unstable grade 5 vascular injury, and failed non-operative management. About 30% of explorations end in nephrectomy, rising to about 85% when Gerota's fascia (zone II) is opened. High-velocity gunshot injuries usually require nephrectomy. ^[1]

Follow-up includes urinalysis, individualised imaging, blood pressure and renal function at about 3 months after major injury, with annual blood pressure monitoring afterwards to detect renovascular hypertension. ^[1]

Ureteric injury. If recognised during operation, ligation is managed by deligation and stenting; partial injuries can be stented antegradely, retrogradely or by a rendezvous approach; complete injuries need spatulated end-to-end anastomosis or reimplantation. In unstable patients a damage-control approach (ligate, divert with nephrostomy, repair later) is preferred. Delayed diagnosis is first treated endourologically, with a success rate of 14 to 19%, and open, laparoscopic or robotic repair if this fails. Injuries shorter than 2 to 3 cm in the proximal or mid ureter suit ureteroureterostomy; longer distal gaps need ureteroneocystostomy, often with a psoas hitch (97% success) or Boari flap (81 to 88% success); buccal mucosa ureteroplasty has about 90% success but limited experience. Late stricture develops in up to 38% of patients after delayed repair. ^[1]

Bladder injury. Management depends on whether rupture is extraperitoneal or intraperitoneal.

Reassessment by cystography at about 10 days applies to traumatic or external iatrogenic extraperitoneal injuries; complex injuries or impaired healing need cystography again a week later if leakage persists. ^[1]

Urethral injury. In PFUI, urinary diversion has priority once life-threatening injuries are controlled. Partial posterior injuries usually heal with diversion alone. Complete posterior disruptions are best managed with suprapubic diversion and deferred urethroplasty after at least 3 months, which has an 86% stricture-free rate with little effect on erectile function or continence. Early endoscopic realignment is an option in stable patients, but evidence of advantage over diversion alone is conflicting; immediate urethroplasty within 48 hours is not recommended. Female PFUI is best repaired early (within 7 days), because stricture occurs in 3%, 59% and 3% after early repair, early realignment and delayed repair respectively, and incontinence in 9% versus 31% after delayed repair. ^[1]

Anterior urethral injuries are treated by depth. Small lacerations can be closed; complete ruptures are anastomosed. Immediate repair is indicated for injuries associated with penile fracture and for non-life-threatening penetrating injuries; only 2% develop stricture after immediate reconstruction for penile fracture. Blunt anterior injuries are usually first managed with diversion because contusion of the spongiosa obscures debridement margins; diversion is maintained 1 to 2 weeks for partial and 3 weeks for complete ruptures. Minor catheter injuries do not require diversion. ^[1]

Erectile dysfunction occurs in about 34% of patients after PFUI regardless of treatment, and reflects the injury itself more than the treatment. ^[1]

Penile fracture. Rupture of the cavernosal tunica albuginea is most often during sexual intercourse (about 60% of cases), favoured by the thinning of the tunica from about 2 mm flaccid to 0.25 to 0.5 mm in erection. Presentation is a snap or pop, pain, immediate detumescence and rapid shaft swelling and ecchymosis. Diagnosis is clinical; in equivocal cases MRI identifies tunical laceration better than ultrasound. Evaluate for urethral injury in 10 to 22% of cases when there is blood at the meatus, gross haematuria or inability to void. ^[1]

Management: prompt surgical exploration and absorbable suture closure of the tunica, using a subcoronal degloving, local or ventral approach. Repair within 24 hours is advised. Immediate repair gives the lowest rate of long-term sequelae; conservative management risks late fibrosis or angulation in about 35% and erectile dysfunction in up to 62% of patients, plus penile abscess, missed urethral disruption, curvature and delayed infection. Postoperative complications occur in up to 20%, and postoperative erectile dysfunction is more common over 50 years or with bilateral corporal involvement; plaque or nodule formation 13.9%, curvature 2.8%, erectile dysfunction 1.9%. ^[1]

"False" penile fracture (subcutaneous haematoma without tunical rupture) should not be operated on unnecessarily; absence of a cracking sound, slow detumescence and limited ecchymosis raise this possibility. ^[1]

Testicular rupture. Blunt trauma ruptures the testis in about 50% of cases presenting for evaluation, requiring a force of about 50 kg; bilateral blunt injury occurs in 1% versus 30% of penetrating scrotal injuries. Surgical exploration is indicated whenever rupture cannot be excluded: evacuate haematoma and clots, excise non-viable tubules and close the tunica albuginea with absorbable sutures. Early exploration preserves the testis in more than 90% of cases; delayed surgery leads to orchiectomy in 45 to 55%. Large haematoceles (more than three times the contralateral testis size) should be evacuated surgically even when the testis is intact, but small haematoceles can be managed non-operatively. Penetrating scrotal injuries require exploration. Military experience has raised testicular salvage in penetrating conflict trauma to about 67.6%. Testicular dislocation is reduced manually with later orchidopexy, or operated; bilateral dislocation occurs in up to 25%. ^[1]

Ischaemic priapism. This is a urological emergency: a painful erection lasting more than 4 hours with tissue hypoxia. Ischaemic priapism is a compartment syndrome of the corpora, and by 4 hours tissue hypoxia and acid accumulation are established; by 24 hours thrombi fill the sinusoidal spaces and smooth muscle is at risk of necrosis. At 24 to 36 hours the rate of erectile dysfunction is around 50%. ^[2][3]

• First, confirm the type. Bedside corporal blood gas shows dark blood with pO2 under 30 mmHg, pCO2 over 60 mmHg and pH under 7.25; non-ischaemic priapism gives bright red blood with high pO2, low pCO2 and normal to slightly basic pH, and does not routinely need intervention. ^[2][3]
• Bedside decompression. After local anaesthesia, an 18 or 19 gauge needle is placed in one corpus cavernosum (basal, 3 and 9 o'clock positions are described) for irrigation and aspiration. Manual pressure and saline irrigation (cold saline at 10 degrees Celsius is reported to improve detumescence) evacuate the ischaemic coagulum. Aspiration alone succeeds in about 30% of cases; the combination of aspiration, irrigation and sympathomimetic succeeds in 43 to 81% of cases. ^[2][3]
• Intracavernosal phenylephrine. Phenylephrine is the preferred agent (100 to 500 micrograms/mL after dilution in normal saline), 200 micrograms every 3 to 5 minutes, to a maximum of 1 mg within 1 hour, with pulse and blood pressure observed every 15 minutes for an hour. Telemetry is needed because hypotension and reflex bradycardia can occur; phenylephrine is avoided in uncontrolled hypertension and in patients taking monoamine oxidase inhibitors. Success after sympathomimetic injection is reported up to 80%. Other agents reported include etilefrine (2.5 mg in 1 to 2 mL saline), adrenaline (2 mL of 1 in 100,000, up to 5 times in 20 minutes) and methylene blue (50 to 100 mg intracavernosally, with caution about penile burning). ^[2][3]
• If medical management fails or priapism is prolonged. Distal shunts (Winter, Ebbehoj, T-shunt, Al-Ghorab) create drainage from the corpora to the glans, with reported success rates from 65 to 75%, but post-ischaemic hyperaemia can close the shunt and create recurrent priapism. Newer tunnelling techniques extend the drainage: the Burnett "snake" (Hegar dilator via a glans incision) achieved resolution in 92% versus 54% for shunt alone (mean duration 58.7 hours), with recovery of penetrative erections in 43% in the reported series; penoscrotal decompression of both corpora had no early recurrence (0 of 15) versus (2 of 10) when done unilaterally. ^[2][3]
• Penile prosthesis. If priapism has lasted more than 36 hours, or shunting fails, implantation may be considered; acute placement carries device infection risk reported as about 6%, versus about 10% with delayed placement, and sub-specialty opinion is that tunneling is now preferred for priapism lasting over 24 hours. Malleable devices are preferred acutely by about three quarters of specialists, and inflatable devices in the delayed setting by about 84%. ^[2][3]
• Recurrent or stuttering priapism. Prevention is the aim: intracavernosal phenylephrine or self-injection protocols, oral agents such as baclofen, gabapentin, finasteride, digoxin, hydroxyurea, pseudoephedrine or PDE-5 inhibitors, alpha-agonists and androgen suppressing agents are all described, with the choice dictated by trigger and comorbidity. Antiandrogens maintain libido, GnRH agonists and estrogens carry cardiovascular and bone risk, and PDE-5 inhibitors are used paradoxically. ^[2][3]

These management steps come from an open review of ischaemic priapism that draws on the AUA/SMSNA guidelines; local protocols and urology advice should guide the exact drugs and doses used in any institution. ^[2][3]

Discuss urgently with urology (and trauma surgery where polytrauma exists) for:

• Haemodynamically significant or grade 4 to 5 renal trauma, an expanding or pulsatile perirenal haematoma, and penetrating renal or ureteric injury.
• Extraperitoneal bladder injury needing surgery (bladder neck or rectal involvement, bone fragments, entrapment) and any intraperitoneal bladder rupture.
• PFUI, suspected testicular rupture, penile fracture, and genital skin loss requiring complex reconstruction.
• Ischaemic priapism, and non-ischaemic priapism with marked bother or failed conservative care.
• Delayed ureteric diagnosis or failed endourological stenting.
• Any patient in whom blood pressure or scrotal pain cannot be controlled, or in whom malignancy is suspected.

Urotrauma is usually managed within trauma networks, and reorganisation to major centres is associated with reduced mortality of 25% and length of stay of four days. ^[1]

• When CT with delayed phases is unavailable, one-shot urography or ultrasound and clinical staging guide referral; one-shot intravenous pyelography may be negative in up to 60% of ureteric injuries. ^[1]
• Extraperitoneal bladder injuries can be managed with catheter drainage in austere settings if follow-up cystography is available. ^[1]
• Where interventional radiology is absent, high-grade renal bleeding is controlled surgically; damage-control nephrectomy may be life saving. ^[1]
• Penile fracture, testicular rupture and ischaemic priapism require theatre access or transfer, not observation. ^[1][2]
• In ischaemic priapism with limited resources, early needle decompression and phenylephrine by a trained clinician are the priority, with local blood pressure monitoring. ^[2]

Related MedGrasp topics in trauma, renal disease and sexual health are conceptually neighbouring and will be linked once verified. No other MedGrasp topic is linked here, to avoid pointing to an unverified page. Renal radiation injury, pelvic fracture management, sickle cell disease and erectile dysfunction are natural follow-ons for the reader. ^[1][2]

• Genitourinary trauma is usually part of polytrauma: resuscitate, then stage and protect function. ^[1]
• Renal trauma occurs in up to 5% of trauma cases; imaging with CT is the standard, and haemodynamic stability not grade alone decides non-operative versus operative care. ^[1]
• Haematuria may be absent in major renal, ureteric and urethral injury; CT gives the grade. ^[1]
• Non-operative renal care with selective angioembolisation succeeds in up to 94.9% of grade 3, 89% of grade 4 and 76% of grade 5 blunt injuries. ^[1]
• Ureteric injury is often iatrogenic, presents late and is diagnosed by CT urography; endourological treatment succeeds in 14 to 19%. ^[1]
• Bladder rupture is intraperitoneal (38.9 to 65.8% of blunt injuries, dome) or extraperitoneal (22.4 to 61.1%, pelvic fracture); cystography with at least 300 to 350 mL identifies it. ^[1]
• Intraperitoneal bladder rupture must be repaired; extraperitoneal rupture is usually treated with catheter drainage, with cystography at about 10 days for traumatic cases. ^[1]
• RUG with 20 to 30 mL contrast at 30 degrees is the standard test for male urethral injury; never insert a catheter blindly against resistance. ^[1]
• PFUI is managed by urinary diversion first; complete disruption requires deferred urethroplasty after at least 3 months, with 86% stricture-free success. ^[1]
• Penile fracture and testicular rupture are surgical emergencies; repair within 24 hours and early exploration preserve function. ^[1]
• Ischaemic priapism is a compartment syndrome: aim for resolution within 4 hours, about half of patients have erectile dysfunction after 24 to 36 hours. ^[2][3]
• Bedside management of ischaemic priapism is aspiration plus irrigation (cold saline reported) and intracavernosal phenylephrine at 200 micrograms every 3 to 5 minutes, to 1 mg per hour. ^[2][3]
• Refractory or prolonged ischaemic priapism may need shunting or newer tunnelling techniques, and priapism beyond 36 hours may warrant implantation. ^[2][3]