A 35-year-old man with a crush pelvic fracture has blood at the external urethral meatus, a high-riding prostate on rectal examination and scrotal ecchymosis. Before any bladder instrumentation, which investigation should be performed?

• A Retrograde urethrogram ✓
• B CT cystogram
• C Ultrasound of the pelvis
• D Diagnostic peritoneal lavage

Explanation

Blood at the meatus, a high-riding prostate and scrotal or perineal bruising are classic signs of posterior urethral injury associated with pelvic fracture. Passing a Foley catheter blindly risks converting a partial tear into complete transection, so catheterisation is contraindicated until the urethra is imaged. Retrograde urethrogram is the investigation of choice and demonstrates extravasation and the site of injury. CT cystogram evaluates the bladder after urethral integrity is established, and ultrasound or lavage add nothing to defining the urethra.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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