A 40-year-old man is brought after a high-speed road accident with a fractured pelvis and inability to pass urine. There is blood at the external urethral meatus, and rectal examination shows a high-riding prostate. What is the correct immediate management of his urinary tract injury?

• A Pass a soft Foley catheter gently per urethram
• B Insert an indwelling catheter and apply traction for realignment
• C Perform suprapubic catheterisation for bladder drainage ✓
• D Immediate open exploration and suture repair of the urethra

Explanation

Blood at the meatus with a high-riding prostate after pelvic fracture indicates posterior urethral disruption. Blind urethral catheterisation is absolutely contraindicated because it can convert a partial tear into a complete one and introduce infection into a pelvic haematoma. Initial management is drainage by suprapubic cystostomy, with definitive urethroplasty deferred until later. Open exploration of the pelvic haematoma risks uncontrollable bleeding, and traction realignment is not the routine first step.

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.