Question
A patient who has fallen over a loose manhole cover is brought to the clinic. On examination, a perineal hematoma and blood in the Urethral meatus is noted. Rupture of which of the following structure has resulted in perineal hematoma?
| A. |
Rupture of membranous urethra |
| B. |
Rupture of bulbar urethra |
| C. |
Pelvic organ blunt trauma |
| D. |
Rupture of bladder |
Show Answer
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Correct Answer » B Explanation |
 |
- The patient has sustained an astride injury, in which the perineum strikes a hard object.
- This mechanism classically causes injury to the bulbar (bulbous) urethra, which is the most vulnerable part of the anterior urethra.
- Clinical features include:
- Blood at the urethral meatus.
- Perineal pain.
- Perineal (“butterfly”) hematoma.
- Difficulty or inability to void.
- If Buck’s fascia is disrupted, urine and blood may extravasate into the superficial perineal space, scrotum, penis, and lower anterior abdominal wall.
Why Other Options are Incorrect
A. Membranous urethra
- Membranous urethral rupture is classically associated with pelvic fractures, not astride injuries.
- Although perineal bruising or hematoma may occur if the perineal membrane is disrupted, the typical presentation is:
- Pelvic hematoma.
- Blood at the urethral meatus.
- Inability to void.
- High-riding or non-palpable prostate.
- The mechanism described in the question favors bulbar urethral injury.
C. Pelvic organ due to blunt trauma
- This is a nonspecific option.
- It does not explain the characteristic findings of urethral injury.
D. Urinary bladder
- Bladder rupture usually follows pelvic fractures or trauma to a distended bladder.
- Presents with suprapubic pain, inability to void, hematuria, and urinary extravasation.
- It does not typically cause a perineal hematoma.