Question

A man under alcohol intoxication had fallen into a manhole and had a perineal injury with swollen scrotum and upper thigh along with blood at meatus. The patient is having difficulty passing urine as well. What will be the injury associated due to this trauma?

• A. Bladder rupture
• B. Penile fracture
• C. Bulbar urethra
• D. Membranous urethra

Answer 1

The Correct Option is C

The clinical scenario described involves a perineal injury with symptoms including swollen scrotum and upper thigh, alongside blood at the meatus, and difficulty in passing urine. These signs are indicative of a urethral injury.

Given the nature of the injury and its location, let's analyze the possibilities:

1. Bladder rupture: Typically associated with pelvic fractures, bladder rupture often presents with gross hematuria and difficulty urinating. However, it generally does not cause localized swelling in the scrotum.
2. Penile fracture: This is characterized by a cracking sound followed by immediate swelling of the penile shaft. Swelling wouldn't extend to the scrotum and thighs, nor is blood at the meatus a typical sign of penile fracture.
3. Bulbar urethra injury: This kind of injury occurs in the anterior urethra, often leading to blood at the meatus, perineal bruising or swelling (butterfly-shaped bruising), and difficulty urinating. These match the symptoms described in the case.
4. Membranous urethra injury: Typically caused by pelvic fractures, this results in blood at the meatus and potential difficulty urinating, but does not cause the characteristic bruising and swelling noted in the anterior urethra injuries.

The combination of symptoms—perineal and scrotal swelling, blood at the meatus, and difficulty urinating—aligns most closely with an injury to the bulbar urethra. This location is consistent with blunt perineal trauma experienced during a fall.

Therefore, the associated injury due to this trauma is bulbar urethra injury.