A 30-year-old man sustains an anterior compression pelvic fracture in a road traffic accident. There is blood at the external urethral meatus and the prostate feels high and boggy on rectal examination. What is the correct next step regarding urinary drainage?

• A Pass a Foley catheter immediately and inflate the balloon if urine drains
• B Perform CT cystography first to exclude bladder rupture
• C Perform retrograde urethrography before attempting catheterisation ✓
• D Insert a suprapubic catheter blindly at the bedside

Explanation

Blood at the meatus with a high riding prostate indicates posterior urethral injury, classically from pelvic fracture shearing the membranous urethra at the urogenital diaphragm. Blind catheterisation can convert a partial tear into complete transection, so retrograde urethrography must precede any urethral instrumentation. CT cystogram assesses the bladder, not the urethra, and blind suprapubic puncture is unsafe in a distorted, haematoma filled pelvis.

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.