Question
A 47-year-old man is brought to the emergency department 1 hour after injuring his genital area when he fell astride his backyard fence. He was trimming a tree from the fence when he lost his balance. His vital signs are within normal limits. Examination shows blood at the urethral meatus, perineal ecchymosis, and a scrotal hematoma. An x-ray of the pelvis shows swelling of the soft tissue but no other abnormalities. Which part of the urinary tract is most likely damaged in this patient?
| A. |
Membranous urethra
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| B. |
Bulbous urethra
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| C. |
Anterior bladder wall
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| D. |
Penile urethra
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Show Answer
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Correct Answer � B
Explanation
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Answer B) Bulbous urethra
This man straddled an object and struck the genital area when he fell, which is known as a straddle injury. Damage to urinary structures occurs when soft tissues are crushed between the pelvic bone (pubic symphysis) and the straddled object.
Bulbous urethra
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The bulbous urethra lies in close proximity to the pubic symphysis, is relatively immobile, and lacks the protection of the corpora cavernosa.
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As a result, it is the most commonly injured structure in men with straddle injuries or direct trauma (e.g., receiving a direct blow or kick) to the male perineum. This patient’s findings of blood at the urethral meatus, perineal ecchymosis, and a scrotal hematoma are classic findings of urethral injury.
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When a urethral injury is suspected, a retrograde urethrogram should be obtained before placement of a Foley catheter. If the bladder needs to be urgently drained before imaging, a suprapubic catheter can be placed.
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