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 –
**Core Concept**
The question pertains to the management of a patient with a pelvic fracture and urethral injury, specifically focusing on the anatomy of the urethra and the principles of urethral injury assessment.
**Why the Correct Answer is Right**
The correct answer is A. The anterior urethra is less likely to be injured in the setting of a pelvic fracture. The anterior urethra is the part of the urethra that runs through the penis, whereas the posterior urethra is the part that runs through the pelvic floor. In pelvic fractures, the posterior urethra is more likely to be injured due to the increased stress on the pelvic floor. The posterior urethra is also more likely to be compressed or disrupted in such cases, leading to a higher likelihood of injury.
**Why Each Wrong Option is Incorrect**
**Option B:** Retrograde urethrography (RGU) should be done before the patient is stabilized, not after. RGU is a diagnostic procedure that involves injecting contrast material into the urethra to visualize the urethral lumen and identify any injuries. Performing RGU after the patient is stabilized may delay diagnosis and treatment of urethral injuries.
**Option C:** A Foley catheter should not be passed if there is a suspicion of urethral injury, even if the RGU is normal. The presence of blood at the urethral meatus is a red flag for urethral injury, and passing a Foley catheter can exacerbate the injury. A Foley catheter should only be passed under direct visualization or after a thorough evaluation to rule out urethral injury.
**Option D:** A rectal examination may reveal a large pelvic hematoma, but the prostate will not be displaced superiorly. In the setting of a pelvic fracture, the prostate gland may be displaced inferiorly or laterally due to the increased stress on the pelvic floor, but not superiorly.
**Clinical Pearl / High-Yield Fact**
In the setting of a pelvic fracture, a high index of suspicion for urethral injury should be maintained, and a Foley catheter should not be passed without a thorough evaluation to rule out urethral injury.
**✓ Correct Answer: A. Anterior urethra is the most likely site of injury**