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Urine
Extravasation
What is
Urine Extravasation?
Extravasation is the process of exuding or
passing out of a vessel into surrounding
tissues; said or blood or lymph or urine.
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Effects
of Urine Extravasation
The
effects of extravasated urine are dramatic. The
combination of urine and infection produces
severe oedema of a patient's scrotum and
abdominal wall. If this is not treated, the skin
over his scrotum, penis, and anterior abdominal
wall may slough. He may be very ill, toxic,
febrile, dehydrated, anaemic, or uraemic, or all
of these things. If his renal function is
impaired, as it often is after a long standing
stricture, extravasation may kill him.
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Your Consultation
The
spontaneous extravasation of urine can be
diagnosed by Intravenous urography or
Ultrasound.
Assess the patient's fluid and electrolyte state
before surgery. He will probably benefit from
intravenous fluid replacement, which may be
life-saving.
Control infection with antibiotics.
Chloramphenicol will probably be suitable.
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The
Urine Extravasation Procedure
Lay him supine, give him a general anaesthetic
and perioperative antibiotics (ampicillin,
trimethoprim, or gentamicin). Clean his abdomen,
penis, and scrotum, and the upper half of his
thighs with 1% cetrimide, followed by 1%
alcoholic iodine.
(1)
Make 5
cm incisions on each side of the base of his
penis. Insert your index finger, and open up the
tissue planes widely towards his abdomen, and
down the shaft of his penis. (2) Make 5 cm
incisions on the inferolateral aspects of his
scrotum, and use your finger to open up the
tissue planes as far as possible. Place two long
corrugated rubber drains into the depth of each
wound in each direction, and suture them in
place. Dress the wounds with gauze and cotton
wool.
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Recovery
Bath
him in a bowl of salt water each day. The
swelling will usually settle in about 5 days.
Shorten the drains 5 cm a day. Areas of necrotic
skin and subcutaneous tissue will form. These
will take a long time to separate spontaneously,
so excise them. When infection has subsided,
close the skin incisions by secondary suture,
and graft the bare areas (57.2). Don't attempt
bouginage again until he is much improved, say
at 4 to 6 weeks.
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Risks
Extravasation of irrigating fluid can be a life
threatening complication when it is
unrecognized. The operating room personnel must
monitor the input of fluid versus the output
from bladder drainage and loss at the table.
When a difference of 500cc is reached,
consideration should be given to terminating the
procedure. Aggressive diuresis and careful
electrolyte management are required. Absorption
of cold irrigation fluid has more of an effect
on thermoregulation than warmed solution. Most
patients will recover without long term sequela.
Frequently Asked Questions
Q:
What is extravasation?
A:
Extravasation refers to the leakage of a fluid
out of its container. In the case of
inflammation,
it refers to the movement of white blood cells
from the capillaries to the tissues surrounding
it. In the case of malignant cancer metastasis
it refers to cancer cells exiting the
capillaries and entering organs.
Q:
What causes extravasation?
A:
Extravasation is usually associated with acute
obstruction and occurs as the result of
increased hydrostatic pressure in the renal
sinus.
The following list of Urology procedures are
performed at Beverly Hills Medical Group -
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