A 24-year-old man struck by a vehicle presents with pelvic pain and blood at the external urethral meatus. On rectal examination the prostate is high riding and boggy. The correct next step regarding urinary catheterisation is:

• A Insert a Foley catheter immediately to monitor urine output
• B Insert a suprapubic catheter under ultrasound guidance as the first step
• C Perform a retrograde urethrogram before any attempt at catheterisation ✓
• D Attempt catheterisation only if urinalysis shows microscopic haematuria

Explanation

Blood at the meatus, a high riding prostate, scrotal haematoma, and perineal bruising are classic signs of posterior urethral disruption, usually at the membranous urethra associated with pelvic fracture. Blind passage of a catheter risks converting a partial tear into complete transection. A retrograde urethrogram must be performed first; suprapubic diversion follows only if the study confirms injury.

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.