Extravasation of urine

Superficial extravasation is likely with complete rupture of the bulbar urethra and in ruptured urethral abscess.

The extravasated urine is confined in front of the midperineal point by the attachment of Colles fascia to the triangular ligament, and by the attachment of Scarpa’s fascia just below the inguinal ligament. The external spermatic fascia stops it getting into the inguinal canals. Extravasated urine collects in the scrotum and penis and beneath the deep layer of superficial fascia in the abdominal wall.

Treatment is by urgent operation to drain the bladder by suprapubic cystostomy. This prevents further extravasation.

Deep extravasation (Fig. 67.7) occurs with extraperitoneal rupture of the bladder or intrapelvic rupture of the urethra. It can also occur if the ureter is damaged or if there is perforation of the prostatic capsule or bladder during trans­urethral resection. Urine extravasates in the layers of the pelvic fascia and the retroperitoneal tissues.

Treatment is by suprapubic cytostomy and drainage of the retropubic space.