A 28-year-old man involved in a road traffic accident has a unstable pelvic fracture. There is blood at the external urethral meatus and digital rectal examination reveals a high riding prostate. Before any bladder catheterisation, the most appropriate next investigation is:

• A Plain abdominal radiograph
• B CT cystogram via suprapubic puncture
• C Flexible cystoscopy in the emergency department
• D Retrograde urethrogram ✓

Explanation

Blood at the meatus, a high riding prostate, scrotal haematoma or inability to void suggests urethral injury, typically bulbar or membranous disruption associated with pelvic fracture. Attempted catheterisation can convert a partial tear into complete transection. D retrograde urethrogram performed before any instrumentation confirms the injury and its site. Suprapubic catheterisation is the safe alternative for bladder drainage once the urethrogram is done, and cystoscopy is reserved for selected cases after imaging.

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.