A 30-year-old man with an unstable pelvic ring fracture has blood at the external urethral meatus and a high-riding prostate on digital rectal examination. The bladder is palpable. What should be done before inserting a urinary catheter?

• A Insert a suprapubic catheter under ultrasound guidance
• B Perform flexible cystoscopy in the emergency department
• C Pass a soft silicone Foley catheter gently
• D Perform retrograde urethrography ✓

Explanation

Blood at the meatus and a high-riding prostate are classic signs of posterior urethral injury. Passing a catheter blindly risks converting a partial tear into complete transection. Retrograde urethrography is the initial diagnostic study and must precede any catheterisation. If the urethra is intact, a catheter may then be passed; if disrupted, suprapubic drainage is performed. Flexible cystoscopy is reserved for cases where urethrography is inconclusive.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.