A 35-year-old engineer presented with bleeding from external meatus and perineal hematoma, after he fell astride on a scaffolding, half-an-hour back. The patient had not passed urine since the accident. On physical examination there was no evidence of extravasation of urine and the bladder was not distended. What would be the immediate management?

**Core Concept**
The patient's presentation is consistent with a posterior urethral injury, likely due to a urethral straddle injury or pelvic fracture, causing urethral disruption and subsequent bleeding. This condition requires prompt management to prevent further complications.

**Why the Correct Answer is Right**
The immediate management of a suspected posterior urethral injury involves a retrograde urethrogram (RUG) to confirm the diagnosis and assess the extent of the injury. A RUG is a diagnostic imaging technique where a contrast agent is injected into the urethra to visualize any disruptions or leaks. This helps in planning the appropriate treatment, which may include catheterization or surgical intervention. The patient's inability to pass urine and the presence of bleeding from the external meatus and perineal hematoma are indicative of a urethral injury.

**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because immediate catheterization is contraindicated in suspected posterior urethral injuries, as it can exacerbate the injury and lead to further bleeding.
**Option B:** While this option is a part of the management, it is not the immediate step. The first step is to confirm the diagnosis with a RUG.
**Option C:** This option is incorrect because it does not address the immediate need to confirm the diagnosis and plan the appropriate treatment.

**Clinical Pearl / High-Yield Fact**
In cases of suspected urethral injury, it is essential to remember the "3 Ps": Pain, Perineal hematoma, and Pelvic fracture. The presence of any two of these factors should raise suspicion of a urethral injury.

**Correct Answer:** B. A retrograde urethrogram should be performed to confirm the diagnosis and assess the extent of the injury.

✓ Correct Answer: B. Assess the urethral injury by ascending urethrography