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Blood at the urethral meatus
A 12-year-old boy falls astride the top bar of his bicycle. He has blood at the urethral meatus, can't pass urine, and develops swelling and bruising of the scrotum and penis.
Step 1 of 4
Which part of the urethra is most likely injured?
Correct answer: C
A straddle injury crushes the bulbar (spongy) urethra against the pubic arch (see urethra).
Show answer
C
A straddle injury crushes the bulbar (spongy) urethra against the pubic arch (see urethra).
Step 2 of 4
Where can the extravasated urine and blood spread?
Correct answer: C
The fluid spreads in the superficial perineal pouch, deep to Colles fascia, which is continuous with the dartos and Scarpa fascia. It can't enter the thighs because Scarpa/Colles fascia fuses with the fascia lata just below the inguinal ligament, or the anal triangle because it fuses at the perineal body (see perineal pouches).
Show answer
C
The fluid spreads in the superficial perineal pouch, deep to Colles fascia, which is continuous with the dartos and Scarpa fascia. It can't enter the thighs because Scarpa/Colles fascia fuses with the fascia lata just below the inguinal ligament, or the anal triangle because it fuses at the perineal body (see perineal pouches).
Step 3 of 4
A different patient, a 30-year-old man crushed in a car crash, has a pelvic fracture and blood at the meatus.
Which part of the urethra is usually injured in a pelvic fracture, and where does urine collect?
Correct answer: C
A pelvic fracture shears the membranous urethra at the prostatomembranous junction. Urine extravasates into the deep perineal pouch and the retropubic (extraperitoneal) space.
Show answer
C
A pelvic fracture shears the membranous urethra at the prostatomembranous junction. Urine extravasates into the deep perineal pouch and the retropubic (extraperitoneal) space.
Step 4 of 4
What is the next step for his urinary tract?
Correct answer: C
With a pelvic fracture and blood at the meatus, do not pass a Foley until a retrograde urethrogram excludes urethral injury. A suprapubic catheter is used if the urethra is disrupted.
Show answer
C
With a pelvic fracture and blood at the meatus, do not pass a Foley until a retrograde urethrogram excludes urethral injury. A suprapubic catheter is used if the urethra is disrupted.
Key points
- Straddle injury → bulbar urethra → scrotum, penis and abdominal wall, not the thighs.
- Pelvic fracture → membranous urethra → deep pouch and retropubic space.
- Blood at the meatus → retrograde urethrogram before a Foley.
Study: Urethra, Perineal pouches, Bony pelvis, Perineum