A 40-year-old man involved in a road traffic accident has a displaced pelvic fracture. On examination there is blood at the external urethral meatus and the prostate feels high riding on digital rectal examination. Before inserting a urinary catheter, the next step should be:

• A Perform a retrograde urethrogram ✓
• B Insert a Foley catheter gently with copious lubrication
• C Perform an ascending cystogram via suprapubic puncture immediately
• D Insert a soft silicone catheter under ultrasound guidance

Explanation

Blood at the meatus with a high riding prostate signals posterior urethral disruption, classically at the membranous urethra below the puboprostatic ligaments. Attempting catheterisation can convert a partial tear into a complete transection, so a retrograde urethrogram must be performed first to define the anatomy. If the urethrogram confirms injury, drainage is achieved by suprapubic catheterisation with delayed urethroplasty. The cystogram assesses the bladder, not the urethra, and cannot be performed safely before the urethra is evaluated.

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.