What findings on a trauma pelvic radiograph should suggest further evaluation of the urethra with a retrograde urethrogram?
pubic rami fractures, pubic symphysis diastasis
On the scout radiographs, the patient has a number of small metallic bodies in the pelvis, compatible with the history of a gunshot wound.
On the RUG, there is a leak at the level of the bulbar urethra and a beak-like cessation of contrast far below the external sphincter.
On the VCUG, contrast is administered via the patient's indwelling suprapubic catheter. The posterior urethra opens normally, but there is a leak at the level of the bulbar urethra and evidence of a transection just upstream from the penoscrotal junction. The radio-opaque disc is an internal control for measurement (known diameter of 13 mm).
On the post image, there is a small amount of contrast in the left side of the perineum and scrotal tissue.