A 25-year-old man sustains a pelvic fracture in a road traffic accident. There is blood at the external urethral meatus and the prostate feels high riding on rectal examination. The bladder is palpable and he has not passed urine. What is the correct immediate approach to urinary drainage?

• A Pass a Foley catheter gently; resistance indicates need for suprapubic cystostomy
• B Insert a suprapubic catheter under ultrasound guidance directly
• C Perform retrograde urethrography before any attempt at catheterisation ✓
• D Insert a three way catheter for continuous bladder irrigation

Explanation

Blood at the meatus, a high riding prostate, and inability to void indicate posterior urethral disruption. Attempting blind catheterisation can convert a partial tear into a complete one and may contaminate a pelvic haematoma, so it is contraindicated. Retrograde urethrography confirms the site and extent of injury first. Definitive drainage is then planned, usually by suprapubic cystostomy or by attempted gentle catheterisation by a urologist once the anatomy is defined. Direct suprapubic puncture without imaging risks injury to an abnormally positioned bladder.

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.