A 25-year-old male presents to emergency dept. following a road traffic accident. On examination, there is pelvic fracture and blood at urethral meatus.Following are true about pt except -
The pa of urethra most likely injured in the pelvic fracture is membranous urethra (a pa of post. urethra) Post. Urethra includes -- Prostatic + membranous urethra Anterior urethra includes -- Bulbar + penile urethra The anterior urethra (paicularly bulbar urethra) is injured due to a direct blow to the perineum (straddle injuries*) About other options - (d) The prostate is displaced superiorly (high lying prostate) in membranous urethral injury due to rupture of puboprostatic fascia. A pelvic hematoma is seen in membranous urethral injuries (Perineal hematoma is seen in bulbar urethral injury) (b) Once a urethral injury is suspected the pt. is instructed not to pass urine and a RGU or ascending urethrogram is performed to assess the injury. (c) Catheterization is contraindicated and is passed only if the RGU is normal. Ref : Bailey and Love 25/e p1363
Anterior urethra is most likely site of injury
Retrograde urethrography should be done after the pt is stabilized.
Foley catheter may be carefully passed if the RGU is normal
Rectal examination may reveal a large pelvic hematoma with the prostate displaced superiorly.
Urology