Question:medium
Mr Ramu faced an accident and sustained a straddle injury. He presents with blood at the urethral meatus. What will be the next step in management?
Mr Ramu faced an accident and sustained a straddle injury. He presents with blood at the urethral meatus. What will be the next step in management?
Show Hint
Blood at the urethral meatus after perineal trauma is a contraindication to blind urethral catheterisation.
Updated On: Jun 23, 2026
- Foley's catheter insertion
- Suprapubic catheter (SPC) and drain the urine
- Do retrograde urethrogram
- CECT pelvis
Show Solution
The Correct Option is B
Solution and Explanation
Straddle injury and urethral trauma:
Mechanism: Straddle injury compresses the bulbar (spongy) urethra between a hard surface and the inferior pubic rami. This is the most common site of urethral injury in blunt perineal trauma.
Clinical signs of urethral injury:
- Blood at the urethral meatus (most reliable sign)
- Perineal bruising / butterfly haematoma
- Inability to void (urinary retention)
- High-riding prostate on digital rectal examination (in posterior urethral injuries)
Key management principle:
- Blood at meatus = suspected urethral injury = DO NOT insert Foley catheter (risk of completing a partial tear or creating false passage)
- Safest immediate step: Suprapubic catheter (SPC) insertion to decompress the bladder
- Definitive diagnosis: Retrograde urethrogram using water-soluble contrast (done after securing urinary drainage)
Why SPC over retrograde urethrogram as the next step?
The question asks for the next management step. Bladder decompression via SPC protects the patient immediately. Urethrogram can follow after stabilisation to plan definitive repair.
\[\boxed{\text{Answer: B -- SPC and drain the urine}}\]
Mechanism: Straddle injury compresses the bulbar (spongy) urethra between a hard surface and the inferior pubic rami. This is the most common site of urethral injury in blunt perineal trauma.
Clinical signs of urethral injury:
- Blood at the urethral meatus (most reliable sign)
- Perineal bruising / butterfly haematoma
- Inability to void (urinary retention)
- High-riding prostate on digital rectal examination (in posterior urethral injuries)
Key management principle:
- Blood at meatus = suspected urethral injury = DO NOT insert Foley catheter (risk of completing a partial tear or creating false passage)
- Safest immediate step: Suprapubic catheter (SPC) insertion to decompress the bladder
- Definitive diagnosis: Retrograde urethrogram using water-soluble contrast (done after securing urinary drainage)
Why SPC over retrograde urethrogram as the next step?
The question asks for the next management step. Bladder decompression via SPC protects the patient immediately. Urethrogram can follow after stabilisation to plan definitive repair.
\[\boxed{\text{Answer: B -- SPC and drain the urine}}\]
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