However, not all authors agree with this statement: Zargooshi21 concludes on the basis of his series of 172 patients that routine urethrography is unnecessary.Role of CavernosographyAlthough some authors recommend routine cavernosography on all patients with suspected penile frac- ture,22,23 most reserve it for unusual cases, such as those with delayed presentation24 or discrepancies in clinical findings.12 Proper technique for cavernosography includes injec- tion of 15 to 70 mL of half- to quarter- strength nonionic contrast dye (we recommend diatrizoate meglumine and diatrizoate sodium) directly into the uninvolved corpora under live fluoroscopy. Injection is continued until both corpora are filled and tumescent changes are observed. Anteroposterior and oblique radi- ographs should be obtained over several time intervals. Early films are reviewed for filling defects and extravasation at the suspected hematoma site; 10-minute-delayed films should ascertain for delayed extravasation.12,23,25 Intraoperative cav- ernosography can be performed on the operating room table in an iden- tical manner.25 Primary limitations to cavernosography include the time, expertise, and equipment required to perform the study. Other investiga- tors cite the potential for delay in treatment and the potential of false- negative results (Table 2).6,16,25 Reported complications of cavernosography include allergic reaction, corporal fibrosis, and priapism.26
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