A 26-year-old man sustains a pelvic fracture in a motorcycle accident. On examination there is blood at the external urethral meatus and a high-riding prostate on per rectal examination. Before inserting a urinary catheter, which step should be taken?
- A Insert the Foley catheter gently; resistance indicates the need to stop
- B Perform a retrograde urethrogram before any attempt at catheterisation ✓
- C Perform a suprapubic catheterisation under ultrasound guidance directly
- D Administer intravenous contrast and proceed to CT urography first
Correct answer: B. Perform a retrograde urethrogram before any attempt at catheterisation
Explanation
Blood at the meatus, a high-riding prostate, or scrotal/perineal bruising signals possible urethral injury, most commonly bulbar urethral disruption in pelvic fracture. Attempted blind catheterisation can convert a partial tear into complete transection. A retrograde urethrogram must be performed first. Suprapubic catheterisation is used only after the urethrogram confirms the injury.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.