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

Step 1: Recognize the injury pattern.
A pelvic fracture with blood at the tip of the urethra, the urethral meatus, after trauma is a warning sign of a urethral injury linked to the fracture. This combination is called a pelvic fracture urethral injury.

Step 2: Check statement 1, the key one.
In pelvic fracture urethral injury, the shearing force at the moment of fracture most often tears the posterior urethra, specifically at the prostatomembranous junction, not the anterior urethra. The anterior urethra is more typically hurt by a direct straddle injury, such as falling astride an object, which is a different mechanism from a pelvic fracture. So saying the anterior urethra is the most likely site of injury here is not correct.

Step 3: Check statement 2.
Once the patient's airway, breathing and circulation are stabilized, a retrograde urethrogram, an X-ray study where dye is injected into the urethra, is done to look for a tear or leak before anything is passed into the urethra. This statement is true and reflects the correct order of care.

Step 4: Check statement 3.
If the retrograde urethrogram (RGU) is normal, meaning no dye leaks out, a Foley catheter can then be passed gently by an experienced hand. This statement is true.

Step 5: Check statement 4.
On a rectal examination, a large boggy pelvic hematoma with the prostate felt riding high, displaced upward away from its usual position, is a classic sign pointing to a posterior urethral tear. This statement is true.

Step 6: Final Answer.
The statement that does not hold true is that the anterior urethra is the most likely site of injury, since pelvic fracture urethral injury almost always involves the posterior urethra.
\[ \boxed{\text{The anterior urethra is most likely the site of injury}} \]