A motorcyclist sustains a pelvic fracture. There is blood at the external urethral meatus, a high riding prostate on rectal examination and inability to void. What is the correct initial management?
- A Immediate retrograde urethral catheterisation
- B Immediate primary end-to-end urethral anastomosis
- C Suprapubic catheterisation with deferred urethroplasty ✓
- D Urethral dilatation followed by indwelling catheter
Correct answer: C. Suprapubic catheterisation with deferred urethroplasty
Explanation
Blood at the meatus with a high riding prostate indicates posterior urethral disruption. Attempted catheterisation can convert a partial tear into complete transection, so the bladder is drained by suprapubic cystostomy. Definitive end-to-end anastomotic urethroplasty is performed electively after about 3 months once the haematoma resolves. Immediate primary repair is avoided because of bleeding, infection risk and a high incidence of erectile dysfunction and incontinence.
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.