Question

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?

• A. Foley's catheter insertion
• B. Suprapubic catheter (SPC) and drain the urine
• C. Do retrograde urethrogram
• D. CECT pelvis

Hint:

Blood at the urethral meatus after perineal trauma is a contraindication to blind urethral catheterisation.

Answer 1

The Correct Option is B

Step 1: Identify the clinical diagnosis.
A straddle injury is a perineal trauma caused by falling astride a hard object (e.g., bicycle frame, fence). It compresses the bulbar urethra against the pubic arch. Blood at the urethral meatus is a classic sign of urethral injury (specifically bulbar urethral injury in straddle trauma).

Step 2: Understand the contraindication to Foley catheterisation.
When urethral injury is suspected (blood at meatus, perineal bruising, inability to void, high-riding prostate on DRE), a urethral (Foley) catheter must NOT be inserted blindly. Blind insertion can:
- Convert a partial urethral tear into a complete rupture
- Introduce infection
- Create a false passage

Step 3: Determine the correct next step.
The safest immediate management is insertion of a suprapubic catheter (SPC) to drain the bladder and relieve urinary retention, while avoiding further urethral trauma.

Note on retrograde urethrogram: Retrograde urethrogram is the definitive diagnostic investigation to confirm urethral injury and delineate the site and extent. However, the question asks for the next management step. In clinical practice, if there is clear clinical suspicion of urethral injury (blood at meatus + straddle mechanism), the safest action is to secure the airway (SPC) first. In many exam contexts, the answer is SPC.

Conclusion: The next step is insertion of a suprapubic catheter (SPC) and urinary drainage.