Question

Mr Ramu faced an accident and had straddle injury and presents with blood at urethral meatus. What will be the next step?

• A. Foleys catheter insertion
• B. SPC and drain the urine
• C. Do retrograde urethrogram
• D. CECT pelvis is taken

Answer 1

The Correct Option is B

In the scenario where Mr. Ramu presents with blood at the urethral meatus following a straddle injury, it is crucial to address the potential injury and manage the situation appropriately. The presence of blood at the urethral meatus is a significant indicator of possible urethral injury. Therefore, proceeding with caution is necessary to prevent further damage.

The steps involved in making the decision for the next step are as follows:

• Avoid Foley's Catheter Insertion: Inserting a Foley's catheter in the presence of a suspected urethral injury can exacerbate the damage. Therefore, this option is not appropriate without further investigation.
• Consider Retrograde Urethrogram (RUG): A retrograde urethrogram is typically performed to evaluate the integrity of the urethra. However, in an acute trauma setting with blood at the meatus, immediate decompression of the bladder is prioritized to prevent further complications such as urinary retention.
• Suprapubic Catheter (SPC) and Drain the Urine: The recommended course of action in this situation is to perform a suprapubic catheterization to safely drain the bladder. This approach bypasses the urethra and avoids further potential injury, thus ensuring effective urinary drainage.
• CECT Pelvis: While a contrast-enhanced CT (CECT) of the pelvis can provide detailed information about pelvic structures, it is not urgently required before addressing the acute issue of bladder decompression.

Based on the assessment, the correct and safest next step for Mr. Ramu is SPC and drain the urine. This step helps to manage the immediate risk associated with urinary retention and prevents further urethral damage.