I. Leibovitch et al., PITFALLS IN THE DETECTION OF URINARY EXTRAVASATION FOLLOWING MAJOR URINARY-TRACT RECONSTRUCTIVE SURGERY, Urologia internationalis, 54(2), 1995, pp. 70-73
Urinary extravasation may complicate the postoperative course of urina
ry tract reconstructive surgery. Early diagnosis of extravasation is c
ritical in the postoperative management. In this study we assessed pro
spectively the various diagnostic techniques employed in the detection
and documentation of urinary extravasation in 76 consecutive patients
who underwent major urinary tract reconstructive surgery. Assessment
included measurements of the volume of the fluid obtained from the dra
ins, analysis of serum to fluid creatinine ratio, detection of intrave
nously injected indigo dye and traditional radiographic evaluation. Ur
inary extravasation was detected in 7 patients (9.2%). Increased creat
inine ratio had the highest diagnostic accuracy: 97.3%, sensitivity 71
.4% and specificity 100%. Various radiological investigations had accu
racy of 96%, sensitivity 85.7% and specificity 97.1%. The combined use
of these methods detected all cases of urinary extravasation with sen
sitivity, specificity and total accuracy of 100%. Fluctuations in the
volume of fluid in the drains and intravenous injection of indigo dye
had lower accuracy, sensitivity and specificity and added very little
to the workup. We conclude that radiological investigations and creati
nine ratio analysis are highly accurate complementary methods for the
early detection and monitoring of urinary extravasation following reco
nstructive urinary tract surgery.