Which rectal examination finding would most strongly indicate a urethral injury in a male patient?

• A. A low-riding prostate
• B. The presence of a boggy mass
• C. Absent sphincter tone
• D. A positive Hemoccult

Answer: (D)

The key concept is how a rectal exam helps localize urethral injury after pelvic trauma. A posterior urethral injury disrupts the connection between the urethra and the prostate, allowing the prostate to be displaced upward. On digital rectal examination this presents as a high-riding (elevated) prostate, and this finding most strongly points to urethral injury.

The other options don’t fit this pattern: a low-riding prostate isn’t typical of posterior urethral disruption, a boggy mass could reflect other prostatic or periprostatic conditions, absent sphincter tone suggests nerve or spinal issues rather than urethral injury, and a positive Hemoccult test indicates gastrointestinal bleeding, not urethral injury.