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Patient case: Perineal Injury in a Male

Patient case: Perineal Injury in a Male

Discussion

A 34-year-old male presents to the emergency department following a motorcycle accident. He reports intense pain in the perineal region, with difficulty urinating and swelling between the legs. He describes the injury occurring when he lost control of the bike and fell, landing on the fuel tank directly with his perineum. Upon examination, there is significant bruising and swelling in the perineal area, with a visible hematoma. The patient has not been able to pass urine since the incident. He denies any other major injuries.

The attending physician suspects a urethral injury and requests a retrograde urethrogram (RUG), which confirms a partial rupture of the bulbar urethra. A Foley catheter is inserted to relieve the patient's urinary retention, and plans are made for surgical repair of the urethral injury. The patient is admitted for observation and further management.

Questions
1. What is the most likely cause of the patient's perineal injury?

A) Direct impact from a fall

B) Blunt trauma to the abdomen

C) A sharp object wound

D) Overexertion during physical activity

2. Which diagnostic test confirmed the urethral injury in this patient?

A) Ultrasound

B) CT scan

C) Retrograde urethrogram (RUG)

D) MRI

3. What is the most common symptom associated with urethral injury in this patient?

A) Abdominal pain

B) Difficulty passing urine (urinary retention)

C) Nausea and vomiting

D) Shortness of breath

4. What is the immediate management for this patient’s urinary retention due to urethral injury?

A) Surgical exploration

B) Insertion of a Foley catheter

C) Administration of diuretics

D) Fluid resuscitation

Reveal answers

Answers

1. A) Direct impact from a fall

2. C) Retrograde urethrogram (RUG)

3. B) Difficulty passing urine (urinary retention)

4. B) Insertion of a Foley catheter