A 40-year-old man involved in a motor vehicle collision has a displaced pelvic fracture. Examination reveals blood at the external urethral meatus and a high-riding prostate on digital rectal examination. The correct immediate action regarding urinary catheterisation is:
- A Insert a Foley catheter gently and inflate if urine drains
- B Obtain a retrograde urethrogram before any catheter insertion ✓
- C Perform suprapubic catheterisation under ultrasound guidance
- D Insert a 16 Fr catheter over a guidewire under cystoscopic vision
Correct answer: B. Obtain a retrograde urethrogram before any catheter insertion
Explanation
Blood at the meatus, a high-riding prostate, scrotal haematoma and perineal bruising are classic signs of urethral disruption, almost always involving the bulbar or membranous urethra in pelvic fractures. Blind catheter insertion risks converting a partial tear into complete transection and contaminating a pelvic haematoma. The mandatory first test is a retrograde urethrogram; only after excluding injury should a catheter be passed. Suprapubic diversion is reserved for confirmed complete rupture.
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.