A 30-year-old motorcyclist sustains a pelvic fracture after being run over. He has blood at the external urethral meatus and a high-riding prostate on rectal examination. Which is the correct next step in evaluation?
- A Insert a Foley catheter immediately to decompress the bladder
- B Perform flexible cystoscopy in the emergency department
- C Perform retrograde urethrography before any catheterisation ✓
- D Proceed directly to CT cystography
Correct answer: C. Perform retrograde urethrography before any catheterisation
Explanation
Blood at the meatus with a high-riding prostate signals posterior urethral disruption, classically at the membranous urethra below the prostate. Blind catheterisation can convert a partial tear into a complete transection and is contraindicated. Retrograde urethrography is the diagnostic study of choice and must precede any attempt at catheterisation. Cystography evaluates the bladder, not the urethra, and cystoscopy is not the initial screening tool in this setting.
Reference: Campbell-Walsh Urology, 12th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.