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Testicular torsion — USMLE Step 3 MCQ

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HardSurgery (post-operative, follow-up)Testicular torsionUSMLE Step 3

A hemodynamically stable man has a pelvic-ring fracture after a motorcycle crash. Blood is present at the urethral meatus, the prostate is difficult to palpate, and he cannot void. CT shows a distended bladder without intraperitoneal rupture. What should occur before any transurethral catheter attempt?

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Correct answer: A — Obtain a retrograde urethrogram to define urethral injury

The best answer is “Obtain a retrograde urethrogram to define urethral injury”. Blood at the meatus after pelvic trauma is a classic indication for retrograde urethrography before blind urethral instrumentation. If pelvic-fracture urethral injury is confirmed, prompt urinary drainage is usually established suprapubically, with selected stable patients considered for realignment. A voiding study cannot precede drainage, and immediate formal urethroplasty is not routine initial management.

Reference: American Urological Association Urotrauma Guideline: https://www.auanet.org/documents/Guidelines/PDF/clinical-guidance/Urotrauma.PDF