A 30-year-old man sustained a pelvic ring fracture in a road traffic accident. At the site there was blood at the external meatus, a high-riding prostate on rectal examination, and failure to pass a catheter. He was managed initially with a suprapubic catheter. Six weeks later he has a short gap between the two ends of the disrupted posterior urethra on ascending urethrography. What is the standard next step?

• A Lifelong suprapubic catheterisation
• B Urethral dilation with metal bougies
• C Immediate insertion of a transurethral catheter under ultrasound guidance
• D End-to-end anastomotic urethroplasty via a perineal approach ✓

Explanation

Posterior urethral disruption associated with pelvic fracture is managed in the acute phase by suprapubic diversion alone, allowing the hematoma to settle and the defect to demarcate. After about three months, once the stricture length stabilises, a perineal excision and end-to-end anastomotic urethroplasty gives durable patency rates above 90 percent. Repeated dilation causes false passages and worsening scarring, and chronic suprapubic drainage carries a heavy burden of infection and stones.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.