If a patient with a suspected fracture of the pelvis has some bleeding from the urethra and is unable to pass urine. What should be the next appropriate step in the management?
Urogenital injuries are common in pelvic fractures (5-10%), especially in men. These injuries should be suspected in conscious patients Who is unable to void or who has gross hematuria Bloody urethral discharge Swelling or ecchymosis of the penis or perineum High riding or floating prostate on rectal examination Management No attempt should be made to pass a catheter, as this could conve a paial to a complete tear of urethra. A retrogram should be obtained before attempting to introduce a foley's catheter. Retrograde urethrogram positive: When a paial or complete urethral disruption is diagnosed on retrograde urethrogram then suprapubic cystotomy should be performed. Retrograde urethrogram negative: Catheterization can be safely undeaken Ref: Current Diagnosis & Treatment in Ohopedics 3/e, page 151; Apley's 8/e, page 672-73; Rockwood & Green's fracture in Adults 6/e, Page 1618-1; Watson Jones: Fracture & Joint Injuries 6/e, Page 867.
He should be encouraged to pass urine after being given antibiotics and analgesics
He should be immediately catheterized in the ward
A hot water bottle should be given followed by injection of carbachol
He should be prepared for surgery and catheterization attempted in the O.T.