A 22-year-old man falls astride a crossbar and presents with blood at the urethral meatus, perineal ecchymosis, and inability to pass urine. A urinary catheter should not be inserted. Which is the most appropriate next investigation to confirm the diagnosis before deciding on management?

• A Retrograde urethrogram ✓
• B CT scan of the pelvis with contrast
• C Micturating cystourethrogram
• D Ultrasound of the pelvis

Explanation

Blood at the meatus after a straddle injury suggests anterior urethral injury. Retrograde urethrogram is the gold standard investigation and must be performed before catheterisation to avoid converting a partial tear into a complete disruption. CT pelvis evaluates associated fractures but does not define urethral integrity. MCUG is used for posterior urethral and bladder evaluation.

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.