MEDizzy - A 17-year-old boy while playing in the park slips and falls,

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Combined Surgery

A 17-year-old boy while playing in the park slips and falls, straddling the rail. His father rushes him to the emergency where he complains of inabaility to pass urine. His genital examination is notable for ecchymosis and swelling of the scrotum and perineal region and there is blood at the tip of the meatus. Digital rectal examination is within normal limits. Which of the following is the source of this urinary leakage?

ExplanationD. Rupture of the urethra below the urogenital diaphragm (at the junction between the membranous and the bulbar) from a so-called “straddle injury” causes urine to flow into the scrotum and the perineal region. Penile urethra rupture occurs following a crush injury. Urine will flow into the deep fascia of Buck within the penis. Superior bladder wall rupture, also called dome rupture, is caused by forceful compression of a full bladder. This form of bladder rupture causes urine to flow into the peritoneal cavity. Urethral rupture above the urogenital diaphragm (at the junction of the prostatic and membranous urethra) due to a fractured pelvis or improper catheter insertion causes urine to flow into the retropubic space. On examination, there is blood at the tip of the meatus and DRE reveals a “high-riding” prostate