Spontaneous extravasation of urine from the anterior urethra.

When urine extravasates from the diseased anterior urethra the subcutaneous tissues beneath Colles' and Scarpa's layers are suffused and necrosis of these tissues is inevitable. Traditionally, surgical treatment has been incision and drainage. Despite improvements in systemic antimicrobial therapy mortality rates remain high. Since necrosis of subcutaneous tissue is inevitable and since the extent of suffusion is discernible, we have treated these patients by primary excision of all edematous subcutaneous tissue. Using patients treated conventionally at our own institution as controls we have demonstrated a significant reduction in the mortality rate. We also have demonstrated that certain findings in the initial evaluation of the patient are of value in assessing prognosis.