A 40-year-old man sustains a pelvic fracture in a road traffic accident. He has blood at the urethral meatus, a high riding prostate on rectal examination, and inability to void. What is the correct next step?

• A Attempt blind urethral catheterisation
• B Proceed directly to urethroscopy
• C Insert a suprapubic catheter immediately in the emergency department
• D Perform retrograde urethrography before any catheterisation ✓

Explanation

Blood at the meatus with a high riding prostate signals posterior urethral rupture, usually membranous, from pelvic fracture. Blind catheterisation can convert a partial tear into complete transection, so retrograde urethrography must be done first to define the injury. Suprapubic drainage is used when catheterisation fails or the patient needs transfer, but imaging precedes instrumentation.

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.