A 30-year-old male is brought after a motor vehicle collision with an unstable pelvic ring fracture. Examination shows blood at the urethral meatus and a high-riding prostate on rectal examination. What is the correct next step in urinary tract management?

• A Immediate blind insertion of a Foley catheter to decompress the bladder
• B Retrograde urethrography performed before any attempt at catheterization ✓
• C Diagnostic peritoneal lavage followed by suprapubic catheterization
• D CT urogram and delayed catheterization after laparotomy

Explanation

Blood at the meatus with a high-riding prostate signals a posterior urethral injury until proven otherwise. Blind catheter passage risks completing a partial tear into a complete one and creating a false passage, so retrograde urethrography must come first. Only after the study excludes or defines the injury should a gentle attempt be made, often by a urologist, with suprapubic drainage reserved for confirmed complete rupture.

Reference: Rockwood and Green's Fractures in Adults, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.