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.
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.
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.
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.
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.
What is extravasation?
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.