344 Urological Survey CT urography protocol is possible. Since CT urography is still an evolving technique we believe that further improvement of an optimized protocol will be developed very soon. Dr. Adilson Prando Department of Radiology Vera Cruz Hospital Campinas, São Paulo, Brazil UROGENITAL TRAUMA __________________________________________________________ Traumatic rupture of the urinary bladder: is the suprapubic tube necessary? Parry NG, Rozycki GS, Feliciano DV, Tremblay LN, Cava RA, Voeltz Z, Carney J Department of Surgery, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA J Trauma. 2003; 54: 431-6 Background: Although surgical principles are well accepted for the treatment of an intraperitoneal or extraperitoneal rupture of the urinary bladder, the type and number of drainage catheters needed to obtain a satisfactory outcome with minimal patient morbidity have yet to be determined. Methods: This was a retrospective review of data on injured patients with the diagnosis of an intraperi- toneal or extraperitoneal rupture of the urinary bladder from penetrating or blunt trauma. Results: Of the 51 patients identified, 28 were treated with suprapubic and transurethral catheters, whereas 23 received a transurethral catheter only. Complications and catheter duration times were similar regardless of type of bladder injury or drainage catheter used (p > 0.5). Conclusion: These data suggest that there are similar outcomes and complication rates for patients treated with suprapubic and transurethral catheters versus transurethral catheter only. Transurethral catheters alone seem effective in draining all types of bladder injuries. Editorial Comment For many years, by habit, many of us have been placing suprapubic tubes (SPT) at the time of open bladder repair. However, this is only one of many papers that advocate using only a urethral catheter alone in these patients (1-3). It appears that using a urethral Foley catheter alone allows for low complications with minimal morbidity. The rate of urinary tract infection, in this study at least, is identical between both groups. In no cases in this small group of 51 patients did a patient seem to “require” the SPT (either as a “safety valve” or to facilitate irrigation). Although I agree that most bladder injuries may be treated with urethral catheterization alone, there are some theoretical benefits to using a SPT. Patients with SPTs get their urethral catheters removed 11 days earlier in this series (with continued drainage via SPT), which may be more comfortable for the patient. Also, the suprapubic catheter allows for a theoretic “safety valve” if the urethral catheter becomes clogged or inadvert- ently dislodged, although this was not necessary in this series. There are probably some uncommon cases where a suprapubic tube would be prudent. In cases of severe ongoing hematuria which is observed in the operating room, or in cases of truly devastating bladder injuries (such as close range shotgun wounds to the bladder), an SPT might help to maximize bladder drainage, especially in the unrepairable or unreliably repaired bladder. Otherwise, the data is clear: after bladder repair, consider using just a urethral catheter. We tend to use a 2-way catheter, as we feel that continuous bladder