A 24-year-old man falls astride a beam. He has a scrotal haematoma and blood at the external urethral meatus. The prostate feels high and boggy on rectal examination. There is no meatal stenosis. The next most appropriate investigation is:

• A Insertion of a Foley catheter to decompress the bladder
• B Retrograde urethrogram before any attempt at catheterisation ✓
• C CT cystogram
• D Flexible cystoscopy in the emergency department

Explanation

Blood at the meatus, a high riding boggy prostate and scrotal haematoma constitute the classic triad suggesting posterior urethral injury, typically at the membranous urethra following pelvic or straddle trauma. Attempting blind catheterisation can convert a partial tear into complete disruption. A retrograde urethrogram is the diagnostic test of choice and must precede any instrumentation. If catheterisation becomes necessary later, it should be done gently, ideally under fluoroscopic guidance or by suprapubic route.

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.