Urinary extravasation

Urinary extravasation

1. URINARY EXTRAVASATION
Dept of Urology
Govt Royapettah Hospital and Kilpauk Medical College
Chennai

2. Moderators:
Professors:
•Prof. Dr. G. Sivasankar, M.S., M.Ch.,
•Prof. Dr. A. Senthilvel, M.S., M.Ch.,
Asst Professors:
•Dr. J. Sivabalan, M.S., M.Ch.,
•Dr. R. Bhargavi, M.S., M.Ch.,
•Dr. S. Raju, M.S., M.Ch.,
•Dr. K. Muthurathinam, M.S., M.Ch.,
•Dr. D. Tamilselvan, M.S., M.Ch.,
•Dr. K. Senthilkumar, M.S., M.Ch.
Dept of Urology, GRH and KMC, Chennai. 2

3. URINARY EXTRAVASATION DEFENITION
•Mechanism where urine extravasates into
other cavities in body such as scrotum
,penis,anterior abdominal wall,in the pelvis
and retroperitoneum
3Dept of Urology, GRH and KMC, Chennai.

4. Anatomy
ANTERIOR ABABDOMINAL WALL
•Contains superficial fatty layer (campers)and deep membranous
layer(Scarpas)
4Dept of Urology, GRH and KMC, Chennai.

5. 5Dept of Urology, GRH and KMC, Chennai.

6. 6Dept of Urology, GRH and KMC, Chennai.

7. Superficial perineal space
•It is a space situated in urogenital region superficial to perineal
membrane
•Boundaries
1.Superficial -colles fasicia
2.Deep –Perineal membrane
3.Laterally –ischiopubic rami
4.Posteriorly –closed by fusion of perineal membrane and colles
fascias
5.Anteriorly –open and continuous spaces of scrotum and anterior
abdominal wall, penis
7Dept of Urology, GRH and KMC, Chennai.

8. DEEP PERINEAL SPACE
•Space in urogenital region deep to perineal membrane
BOUNDARIES
1.superficial-perineal membrane
2.Deep –open above
3.Laterally-ischiopubic ramus
4.Anteriorly-gap between the perineal membrane and inferior pubic
ligament
8Dept of Urology, GRH and KMC, Chennai.

9. 9Dept of Urology, GRH and KMC, Chennai.

10. EXTRAVASATION
Extravastion are of two types
1.Superficial extravasation
2.Deep extravasation
10Dept of Urology, GRH and KMC, Chennai.

11. Superficial extravasation
•Superficial extravasation is superficial
to perineal membrane
•Any injuries to the Penile urethra can cause this
•Bulbar utrethra is most commonly injured that leads to extravastion
11Dept of Urology, GRH and KMC, Chennai.

12. Causes of urethral injuries
•Most common cause is instrumentation iatrogenic
•Bends ,narrows ,strictures are the mosr common sites for injury
•Initially bleeds and heals by scarring eventually stricture formation
12Dept of Urology, GRH and KMC, Chennai.

13. •Bulbar urethra rupture are associated with perineal
brusing,hematoma with butterfly distribution
•Bleeding from urethral meatus
•Retention of urine
•Extravasation of urine
13Dept of Urology, GRH and KMC, Chennai.

14. Bucks fascia
•Bucks fascia is deep fascia of penis
•Any injuries to penile urethra if bucks fascia is intact then the
extravastion is limited to penis alone
•Entire penis is swollen
•If bucks fascia breached then urine escapes into the superficial
perineal space thereby spreading to scrotum ,anterior abdominal
wall,tigh
14Dept of Urology, GRH and KMC, Chennai.

15. 15Dept of Urology, GRH and KMC, Chennai.

16. 16Dept of Urology, GRH and KMC, Chennai.

17. Management
•First analgesics and antibiotics
•Pt was discouraged to pass urine
•Suprapubic catheterization
•Urethtrography to look for exact site of injury
•If there is significant large extravasation then emergency drainage of
perineal scrotal collection to be drained
•Delayed anastomotic urethroplasty
17Dept of Urology, GRH and KMC, Chennai.

18. Deep extravasation
•Here extravasation occurs deep to perineal membrane
•Deep extravasation can be due to two reasons
1.Membranous urethral rupture
2.Extraperitoneal bladder injury
Most common cause is pelvic trauma
18Dept of Urology, GRH and KMC, Chennai.

19. 19Dept of Urology, GRH and KMC, Chennai.

20. •In both conditions the urine exravasates into the pelvic cavity
,retroperitoneum and preperitoneal Space
•Vermoonten’s sign
•Mostly scrotum extravastion dosenot occur but can occur by
extravastion through The inguinal canal into the scrotom
20Dept of Urology, GRH and KMC, Chennai.

21. 21Dept of Urology, GRH and KMC, Chennai.

22. Management
•In membranous urethral injury pt has urinary retention ,
,blood at meatus,high riding prostate on rectal examination
•Suprapubic catheterization as early as possible
•Associated extraperitoneal bladder Rupture is there then
Surgical exploration and bladder repair suprapubic catheter placement
and drainage of exravasated urine
22Dept of Urology, GRH and KMC, Chennai.