Urethrocutaneous Fistula

What is a urethrocutaneous fistula?

A urethrocutaneous fistula is an opening or tunnel between your urethra to anywhere along your genital skin and perineum. Your urethra is the tube that allows urine (pee) to leave your body. Your perineum is the thin layer of skin between your anus (butthole) and genitals (vaginal opening or scrotum).

When working as expected, your urethra and sphincter muscles control your pee flow. A urethrocutaneous fistula can bypass your urethra and sphincter muscles and cause pee to leak out of your body. It can also lead to urinary tract infections (UTIs). UTIs can damage your organs and tissues in the surrounding area.

Urethrocutaneous fistulas are rare. Sometimes, they’re congenital (present at birth), and other times, they develop after infection, injury or as a complication after surgery on or near your urethra.

Other names for a urethrocutaneous fistula include:

• Urinary fistula.
• Urethral fistula.

How serious is urinary fistula?

A urinary fistula is serious. It won’t heal on its own, and it requires surgery to treat it.

What are the symptoms of a urethral fistula?

The most common symptoms of a urethral fistula include:

• Pee leaking from the fistula (urinary incontinence).
• Regular (recurrent) UTIs.

What causes a urethrocutaneous fistula?

The most common cause of a urethrocutaneous fistula is a previous surgery, especially hypospadias repair. Other common causes include:

• Infection, which causes a collection of pus (abscess) to develop in tissue. After the abscess clears, it can leave a tunnel behind in the tissue.
• Injury, often when a dull (blunt) object strikes the area (like a baseball or hockey puck) or impact from a straddle injury (like falling onto the crossbar of a bicycle).

In rare cases, a urethrocutaneous fistula is present at birth or develops as a result of mismanaged diabetes (having an A1C greater than 8% for a year or more despite standard care).

What is the risk factor for urethrocutaneous fistula?

Urethrocutaneous fistulas are rare. The greatest risk factor for a urethrocutaneous fistula is having a surgical procedure around your urethra, such as a hypospadias repair, urethroplasty or circumcision.

How is a urethrocutaneous fistula diagnosed?

A healthcare provider might suspect a urethrocutaneous fistula if you have unexplained pee leakage or an unexplained infection in your urinary tract. There are several tests that a healthcare provider can order to check for a urethrocutaneous fistula. These include:

• Voiding cystourethrogram (VCUG). During a VCUG, a provider injects a dye into your bladder. You’ll then pee while on an examination table. This allows the provider to see where the pee goes when it leaves your bladder.
• Retrograde urethrograms or fistulograms. These tests also involve injecting a dye into your bladder and monitoring where the dye goes. They show the location and connections of fistulas.
• Computed tomography (CT) scan. CT scans use X-rays and computers to produce detailed images of the inside of your body. They help providers see greater details and allow them to learn more about fistula-related complications, like the formation of a pocket of pus.
• Cystoscopy. A provider inserts a long, thin instrument (cystoscope) into your urethra. The cystoscope has a lens and a light at the end, which help the provider visualize your urethra and understand the fistula.

How is a urethrocutaneous fistula treated?

Surgery is usually necessary to treat a urethral fistula. But there are many variables a provider must consider before treating it, such as:

• Size.
• Location.
• The possibility of multiple fistulas.

Smaller fistulas (less than 2 millimeters in size) are fairly easy to close. A provider will give you a sedative to help you relax, and then a surgeon will close the fistula with stitches.

Larger fistulas require a more involved procedure. If the skin around your fistula isn’t healthy, the surgeon may need to perform an approach that uses multiple layers of skin. They’ll use flaps of skin from other areas of your body to replace the unhealthy tissue and create a “waterproofing” layer to help seal off the opening.

Most people need to use a urinary catheter to help drain pee from their bladders while they heal after surgery. You may need to spend one night in the hospital after the procedure.

Can a urethral fistula heal itself?

No, a urethral fistula can’t heal itself. Most people require surgery to close a urethral fistula. A healthcare provider who specializes in conditions that affect the urinary and reproductive systems (urologist) can treat a urethral fistula.

How soon after treatment will I feel better?

It’s important to remember that your body is unique, so recovery times may vary. In general, swelling and bruising after surgery to correct a urethrocutaneous fistula should go away after a few weeks. You should make a full recovery after about six weeks.

Can a urethrocutaneous fistula be prevented?

You can’t prevent all causes of urethrocutaneous fistulas. But you can help prevent injuries to the area by:

• Wearing an athletic cup (jockstrap or athletic supporter) while playing sports or participating in other rigorous activities. Make sure it fits properly.
• Always wearing your seatbelt while driving or riding as a passenger in a car.
• Being safe when you’re riding a bicycle. Consider adding padding to the crossbar.

What can I expect if I have a urethrocutaneous fistula?

If you have a urethrocutaneous fistula, the overall outlook is good with treatment. One study found that the success rate for fistula repair is 89%. For people who still have symptoms after surgery, a follow-up surgery with a more complicated layered approach is very effective. You may need to wait at least six months after the first surgery before going through a second surgery to ensure complete healing in the area.

When should I see my healthcare provider?

Schedule regular appointments with your healthcare provider after surgery to repair a urethrocutaneous fistula. They’ll want to ensure you’re healing properly. If you still have symptoms, they may schedule another surgery.

When should I go to the ER?

Go to the nearest emergency room if you have any of the following symptoms after surgery to repair a urethrocutaneous fistula:

• Heavy bleeding in the affected area.
• A fever of 100 degrees Fahrenheit (38 degrees Celsius) or higher.
• Increased pain.
• Trouble peeing.
• Blood in your pee (hematuria).

It’s also a good idea to see a healthcare provider if your catheter comes out or if pee is leaking around your catheter.

What questions should I ask my healthcare provider?

You may want to ask your provider:

• How do you know that I have a urethrocutaneous fistula?
• What caused the urethrocutaneous fistula?
• Do I have a small or large urethrocutaneous fistula?
• How should I take care of myself while I have a urethrocutaneous fistula?
• What complications could occur from surgery to repair my urethrocutaneous fistula?
• Can I have sexual intercourse if I have a urethrocutaneous fistula?

A note from Cleveland Clinic

A urethrocutaneous fistula is an unwanted opening that develops between your urethra and perineum. It can cause embarrassing or frustrating problems like urinary incontinence or frequent urinary tract infections. But you don’t have to live with the complications of a urethrocutaneous fistula. Talk to a healthcare provider if you have symptoms. They can surgically close the opening, which should relieve your symptoms.