Question:
An intoxicated man fell into a manhole and sustained a perineal injury. He now has a swollen scrotum and upper thigh, blood at the urethral meatus, and difficulty passing urine. The injury most likely associated with this trauma is:
An intoxicated man fell into a manhole and sustained a perineal injury. He now has a swollen scrotum and upper thigh, blood at the urethral meatus, and difficulty passing urine. The injury most likely associated with this trauma is:
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A fall-astride mechanism crushes which part of the urethra against the pubis?
Updated On: Jun 23, 2026
- Bladder rupture
- Penile fracture
- Bulbar urethral injury
- Membranous urethral injury
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The Correct Option is C
Solution and Explanation
Correct option: Bulbar urethra.
Step 1: The mechanism is a fall astride injury (manhole, bicycle crossbar, gymnasium beam). The bulbar urethra is crushed upward against the inferior pubic bone, which is the classic anterior urethral injury.
Step 2: The signs fit exactly: blood at the meatus, retention of urine, and a perineal/scrotal hematoma that tracks in a butterfly distribution (limited by Colles fascia), which explains the swollen scrotum and upper thigh.
Why not membranous urethra: Membranous (posterior) urethral injury is caused by pelvic fractures, not a straddle injury, and presents with a high-riding prostate.
Bladder rupture follows a full-bladder blow with peritonitis, and penile fracture occurs during erection with a cracking sound and immediate detumescence, neither matching this history.
Ref: Bailey and Love, Short Practice of Surgery, 27th edition, 2018.
Step 1: The mechanism is a fall astride injury (manhole, bicycle crossbar, gymnasium beam). The bulbar urethra is crushed upward against the inferior pubic bone, which is the classic anterior urethral injury.
Step 2: The signs fit exactly: blood at the meatus, retention of urine, and a perineal/scrotal hematoma that tracks in a butterfly distribution (limited by Colles fascia), which explains the swollen scrotum and upper thigh.
Why not membranous urethra: Membranous (posterior) urethral injury is caused by pelvic fractures, not a straddle injury, and presents with a high-riding prostate.
Bladder rupture follows a full-bladder blow with peritonitis, and penile fracture occurs during erection with a cracking sound and immediate detumescence, neither matching this history.
Ref: Bailey and Love, Short Practice of Surgery, 27th edition, 2018.
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