A 30-year-old man sustains a pelvic fracture after a road traffic accident. There is blood at the external urethral meatus and a high riding prostate on rectal examination. What is the correct initial management of his suspected posterior urethral injury?

• A Immediate primary realignment over a catheter in all cases
• B Immediate end-to-end anastomotic urethroplasty
• C Attempted blind urethral catheterisation by a junior doctor
• D Suprapubic catheterisation with delayed urethroplasty ✓

Explanation

Blood at the meatus with a high riding prostate indicates a membranous urethral disruption from pelvic fracture. The accepted initial approach is urinary diversion via a suprapubic catheter (or gentle endoscopic primary realignment in stable patients) followed by delayed anastomotic urethroplasty at 3 to 6 months. Immediate open repair carries a high rate of erectile dysfunction and incontinence. Blind catheterisation risks converting a partial tear into a complete one. Primary end-to-end urethroplasty is reserved for select specialist centres.

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.