A 25-year-old man sustains an APC-II pelvic ring injury in a road traffic accident. On examination there is blood at the urethral meatus and the prostate feels high riding on rectal examination. What is the correct next step regarding urinary tract evaluation?

• A Insert a Foley catheter immediately to decompress the bladder
• B Obtain a CT cystogram alone and defer urethral assessment
• C Perform diagnostic peritoneal lavage to exclude bladder rupture
• D Perform a retrograde urethrogram before any attempt at catheterization ✓

Explanation

Blood at the meatus and a high riding prostate are classic signs of posterior urethral rupture associated with pelvic ring disruption. Blind passage of a catheter can convert a partial tear into a complete transection, so a retrograde urethrogram must be performed first. A cystogram evaluates the bladder but does not assess the urethra, and it should follow urethral imaging when bladder injury is suspected.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.