A 22-year-old man fell astride a bicycle crossbar, striking his perineum. He has perineal pain and blood at the external urethral meatus, with a normal scrotum and palpable prostate on rectal examination. What is the most appropriate next investigation?
- A Urethral catheterisation under aseptic precautions
- B Retrograde urethrography ✓
- C Flexible cystoscopy
- D Micturating cystourethrogram
Correct answer: B. Retrograde urethrography
Explanation
Blood at the meatus after a straddle injury indicates anterior (bulbar) urethral injury. Retrograde urethrography is the investigation of choice as it defines the site and extent of the rupture without risk of converting a partial tear into a complete one. Catheterisation before imaging is contraindicated because blind passage can worsen the tear. Cystoscopy is invasive and adds nothing over urethrography, and a micturating cystourethrogram is used later or in children for posterior urethral assessment.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.