A 30-year-old man is brought to the emergency department after a road traffic accident. He has a fracture of the pubic rami, blood at the external urinary meatus, and is unable to void. The prostate feels high and mobile on rectal examination. What is the correct next step?
- A Pass a Foley catheter per urethram gently
- B Insert a Foley catheter under cystoscopic guidance immediately
- C Perform retrograde urethrography before any instrumentation of the urethra ✓
- D Arrange contrast-enhanced CT of the abdomen and pelvis only
Correct answer: C. Perform retrograde urethrography before any instrumentation of the urethra
Explanation
Blood at the meatus with a high riding prostate after pelvic fracture indicates posterior urethral injury until proven otherwise. Blind or even attempted urethral catheterisation can convert a partial tear into complete disruption and risks infection. Retrograde urethrography is the diagnostic step and must precede any instrumentation; if confirmed, drainage is by suprapubic cystostomy with later urethroplasty. CT defines associated injuries but does not image the urethra adequately.
Reference: Bailey and Love Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.