Question:medium
An intoxicated man fell into a manhole and sustained a perineal injury. He now has a swollen scrotum and upper thigh, blood at the urethral meatus, and difficulty passing urine. The injury most likely associated with this trauma is:
An intoxicated man fell into a manhole and sustained a perineal injury. He now has a swollen scrotum and upper thigh, blood at the urethral meatus, and difficulty passing urine. The injury most likely associated with this trauma is:
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A fall-astride mechanism crushes which part of the urethra against the pubis?
Updated On: Jun 23, 2026
- Bladder rupture
- Penile fracture
- Bulbar urethral injury
- Membranous urethral injury
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The Correct Option is C
Solution and Explanation
Mnemonic approach: Anterior urethra = Astride (Anterior) injury = bulbar.
Think of the two urethral injury patterns. A straddle or fall astride injury hits the ANTERIOR urethra, and the bulbar segment is its most vulnerable part because it is rammed against the lower pubic bone. A pelvic fracture instead shears the POSTERIOR (membranous) urethra.
Reading the clues: butterfly perineal bruising spreading to the scrotum and thigh is the signature of bulbar rupture, because Colles fascia confines the extravasated blood and urine to that exact territory. Blood at the meatus plus an inability to void completes the picture. The history here is a manhole fall (a straddle mechanism), so the answer is the bulbar urethra, not the membranous one. Ref: Bailey and Love, Short Practice of Surgery, 27th edition, 2018.
Think of the two urethral injury patterns. A straddle or fall astride injury hits the ANTERIOR urethra, and the bulbar segment is its most vulnerable part because it is rammed against the lower pubic bone. A pelvic fracture instead shears the POSTERIOR (membranous) urethra.
Reading the clues: butterfly perineal bruising spreading to the scrotum and thigh is the signature of bulbar rupture, because Colles fascia confines the extravasated blood and urine to that exact territory. Blood at the meatus plus an inability to void completes the picture. The history here is a manhole fall (a straddle mechanism), so the answer is the bulbar urethra, not the membranous one. Ref: Bailey and Love, Short Practice of Surgery, 27th edition, 2018.
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