A 40-year-old man presents after a fall from height with a pelvic fracture. He has blood at the external urethral meatus, a high-riding prostate on rectal examination and inability to pass urine. What is the most appropriate next step?

• A Insert a Foley catheter gently per urethra
• B Perform retrograde urethrography before any instrumentation ✓
• C Pass a suprapubic catheter under ultrasound guidance only
• D Perform flexible cystoscopy and catheterise over a guidewire

Explanation

Blood at the meatus with a high-riding prostate indicates posterior urethral injury until proven otherwise. Blind urethral catheterisation is contraindicated because it may convert a partial tear into complete transection and risk infection of the pelvic haematoma. Retrograde urethrography is the diagnostic test of choice and must precede instrumentation. Suprapubic diversion is the usual treatment afterwards, but the question asks for the immediate diagnostic step, which is urethrography.

Reference: Smith and Tanagho's General Urology, 19th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.