In suspected bladder injury with pelvic fracture, which is the correct immediate step before catheter placement?

In suspected bladder injury with pelvic fracture, which is the correct immediate step before catheter placement?

• A. Do not place a Foley until a retrograde urethrogram has been performed
• B. Place a Foley catheter immediately
• C. Obtain an abdominal X-ray
• D. Perform pelvic MRI first

Answer: (A)

In a patient with a pelvic fracture and suspected bladder injury, you must check the urethra before attempting urinary catheterization. The immediate step is a retrograde urethrogram, which involves injecting contrast into the distal urethra and imaging for any contrast extravasation indicative of a urethral tear. If a urethral injury is present, inserting a Foley catheter could worsen the tear or create a false passage, complicating treatment. Performing the urethrogram first lets you decide the safest route: if no injury is found, you can place the catheter confidently; if injury is present, you pursue alternative drainage like a suprapubic catheter and address the urethral injury surgically when appropriate. The other options don’t evaluate urethral integrity and would delay or risk mismanagement in this scenario.

In a patient with a pelvic fracture and suspected bladder injury, you must check the urethra before attempting urinary catheterization. The immediate step is a retrograde urethrogram, which involves injecting contrast into the distal urethra and imaging for any contrast extravasation indicative of a urethral tear. If a urethral injury is present, inserting a Foley catheter could worsen the tear or create a false passage, complicating treatment. Performing the urethrogram first lets you decide the safest route: if no injury is found, you can place the catheter confidently; if injury is present, you pursue alternative drainage like a suprapubic catheter and address the urethral injury surgically when appropriate. The other options don’t evaluate urethral integrity and would delay or risk mismanagement in this scenario.