Urethral Catheterization Before Penile Fracture Exploration
Do not routinely catheterize the urethra before surgical exploration in penile fracture unless there are specific signs of urethral injury—blood at the meatus, gross hematuria, or inability to void.
When to Evaluate for Urethral Injury
The decision to investigate the urethra depends entirely on clinical presentation:
- Evaluate for urethral injury only if the patient presents with blood at the urethral meatus, gross hematuria, or inability to void 1
- Additional risk factor: Bilateral corporal body fracture increases suspicion for concomitant urethral injury 1
- Urethral injury occurs in approximately 10-38% of penile fractures when these signs are present 2
Diagnostic Approach When Urethral Injury is Suspected
If signs of urethral injury are present:
- Perform urethroscopy or retrograde urethrogram before attempting urethral catheterization 1
- Flexible cystoscopy in the operating room is preferred over retrograde urethrogram, as retrograde studies may miss urethral injuries 3
- In one series, retrograde urethrograms failed to reveal urethral injury in all three cases where it was present 3
- For penile lesions specifically, urethroscopy is recommended over retrograde urethrography 1
Management Algorithm
For patients WITHOUT signs of urethral injury:
- Proceed directly to surgical exploration and repair 1
- No preoperative imaging or catheterization is necessary 1
- History and physical examination alone are diagnostic in most cases 1, 4
For patients WITH signs of urethral injury:
- Perform flexible cystoscopy in the operating room at the time of penile exploration 3
- Do not delay surgical repair for preoperative urethrography 3
- Repair both corporal and urethral injuries during the same operation 2
Critical Pitfalls to Avoid
- Do not blindly catheterize if urethral injury is suspected—this can convert a partial injury to a complete disruption 1
- Do not delay surgical exploration for imaging studies when the diagnosis is clinically evident 1, 3
- Do not rely solely on retrograde urethrogram—it has a high false-negative rate in this setting 3
Surgical Technique Considerations
- Use a subcoronal circumcising incision to deglove the entire penile shaft for complete access to all three corporal bodies and the neurovascular bundle 3
- Saline mixed with indigo carmine can be injected into the corpora cavernosum or corpus spongiosum after tourniquet placement to evaluate surgical repair and identify missed injuries 3
- Immediate surgical repair results in successful outcomes with preservation of sexual function even in the presence of urethral injury 2