Urethral trauma may lead to serious consequences if mismanaged, but the treatment concept is not consistent We design the survey to investigate the current actual situation of diagnosing and managing of emergency urethral trauma, find the gap with the literature evidence. In order to assist the dissemination of relevant concepts in the future.

A 15-item anonymous questionnaire were distributed to members of the Chinese Learning Alliance of Urology. The questionnaire was designed to address the following issues: how to diagnose urethral trauma; optimal emergency management of a urethral trauma patient; and attitude toward early re-alignment for pelvic fracture urethral injuries intervention.

A total of 538 valid responses were received. 507 (94.2%) respondents had received patients with straddle trauma urethral injuries and 457 (84.9%) had received pelvic fracture urethral injuries in last year. For male patients suspected of urethral trauma in emergency room, doctor soften choose attempt catheterization, CT, cysto-urethrography and urethroscopy for diagnosis. For patients with straddle injury, 41.3% respondents usually perform endoscopic re-alignment, 31.6% preferred suprapubic cystostomy. For hemodynamically stable patients with pelvic fracture urethral injury, 42.19% respondents preferred suprapubic cystostomy and 34.9% preferred endoscopic re-alignment. Most respondents held a positive attitude towards early re-alignment for pelvic fracture urethral injuries. After re-alignment, 61.3% respondents retained catheter for 4 weeks, 24.5% for 8 weeks and 13.8% for 12 weeks; 54.6% respondents considered catheter traction after the re-alignment has positive significance.

1.Respondents’ Demographics-
The online anonymous questionnaire was distributed to 2118 members of CLAU. Totally 573 CLAU members responded to the survey, including 538 valid responses. The response rate is 25.4%.
Among the respondents, 507 (94.2%) had received patients with STUIs and 457 (84.9%) had received PFUIs in last year. 

2.The Diagnosis of Urethral Trauma-
When the respondents diagnose urethral trauma in emergency room (ER), they often choose attempt catheterization, CT, cysto-urethrography and urethroscopy. For male patients suspected of STUI in ER, doctors preferred attempt catheterization, urethroscopy and cystourethrography. For male patients with suspected PFUI, the preferred examinations were attempted catheterization, CT and cysto-urethrography.

3.The management of STUIs-
For patients with bulbar urethral injury caused by straddle trauma, when indwelling catheterization failed, 41.3% (222/538) of the respondents usually (or think they should) perform endoscopic re-alignment. The doctors who preferred suprapubic cystostomy and immediate urethroplasty accounted for 31.6% (170 / 538) and 25.5% (137 / 538) respectively.

4.The management of PFUIs-
For hemodynamically stable patients with PFUI within 48 hours after injury, indwelling catheterization failed, 42.19% (227/538) of the respondents preferred suprapubic cystostomy and 34.9% (188/538) preferred endoscopic re-alignment. 99 (18.4%) doctors preferred open re-alignment, only 19 (3.5%) preferred immediate urethroplasty.

5.Attitude towards Early Re-alignment for PFUIs-
For PFUIs, most respondents believed that early re-alignment could effectively reduce the incidence of urethral stenosis. For the posterior urethral stenosis after re-alignment, 254 (47.2%) of the respondents believed that most patients could be cured via endoscopic treatment. After re-alignment for a PFUI patient, 330 (61.3%) respondents considered that the catheter should be retained for about 4 weeks. More than half of the respondents considered catheter traction after the re-alignment has positive significance.

Although the number of emergency urethral trauma cases managed per year by participants was generally small, the opinions and practices of most urologists are consistent with the guidelines. However, still many respondents were excessively cautious about catheter removement after re-alignment, a large number of respondents had incorrect views on catheter traction after re-alignment.