A man is brought to the emergency after he fell into a man hole and injured his perineum. He feels the urge to micturate but is unable to pass urine and there is blood at the tip of the meatus with extensive swelling of the penis and scrotum. What is the location of the injury?

**Core Concept**
The patient's symptoms suggest a urethral injury, specifically a partial or complete disruption of the urethra, which is a common consequence of pelvic fractures or severe perineal trauma. The inability to pass urine (urinary retention) and the presence of blood at the urethral meatus are classic signs of urethral injury.

**Why the Correct Answer is Right**
The location of the injury can be inferred from the patient's symptoms. The extensive swelling of the penis and scrotum indicates a high-riding prostate and possible disruption of the urethra at the level of the membranous urethra. This is because the membranous urethra is surrounded by the urogenital diaphragm and is more susceptible to injury in the setting of pelvic fractures. The presence of blood at the urethral meatus suggests a partial or complete rupture of the urethra.

**Why Each Wrong Option is Incorrect**
* **Option A:** The bulbar urethra is located in the spongy part of the penis and is less likely to be injured in the setting of perineal trauma.
* **Option B:** The prostatic urethra is located within the prostate gland and is not typically injured in the setting of perineal trauma.
* **Option C:** The penile urethra is located in the shaft of the penis and is not typically injured in the setting of perineal trauma.

**Clinical Pearl / High-Yield Fact**
In the setting of perineal trauma, it is essential to perform a thorough examination and consider the possibility of urethral injury, even in the absence of overt symptoms. A high index of suspicion and prompt evaluation can help prevent long-term complications.

**Correct Answer:** D

✓ Correct Answer: A. Bulbar urethra