Question

A 25 year old male presents to the emergency department following a road traffic accident. On examination there is a pelvic fracture and blood at the urethral meatus. All the following are true about this patient except:

• A. The anterior urethra is most likely the site of injury
• B. Retrograde urethrography should be done after the patient is stabilized
• C. A Foley catheter may be carefully passed if RGU is normal
• D. Rectal examination may reveal a large pelvic hematoma with the prostate displaced superiorly

Hint:

Pelvic fracture injures the posterior, membranous urethra, not the anterior urethra.

Answer 1

The Correct Option is A

We need to spot the one FALSE statement about a patient with a pelvic fracture and blood at the urethral meatus, a picture that points to urethral injury tied to the fracture.

1. The anterior urethra is most likely the site of injury: False. A pelvic fracture stretches and shears the posterior urethra, most often right at the prostatomembranous junction. The anterior urethra is usually hurt by a direct straddle injury, a completely different mechanism, so it is not the likely site here.
2. Retrograde urethrography should be done after the patient is stabilized: True. Once the patient is out of immediate danger, injecting dye into the urethra under X-ray shows whether the urethra is torn before any instrument is passed.
3. A Foley catheter may be carefully passed if RGU is normal: True. A normal retrograde urethrogram, with no dye leak, means the urethra is intact enough that a soft catheter can be passed gently.
4. Rectal examination may reveal a large pelvic hematoma with the prostate displaced superiorly: True. A high-riding prostate felt on rectal exam, sitting in a boggy hematoma, is a textbook sign of a posterior urethral tear.

Three of the four statements describe the accepted picture and workup of pelvic fracture urethral injury. The one that does not fit is the claim about the anterior urethra, since the injury in this setting sits in the posterior urethra.

Let's summarize:

• Pelvic fracture urethral injury affects the posterior, membranous urethra, not the anterior urethra.
• Retrograde urethrography before catheterization, and a high-riding prostate on rectal exam, are both standard and correct findings and steps.

So the false statement is that the anterior urethra is most likely the site of injury.