Urethrocutaneous Fistula

Overview

What is a urethrocutaneous fistula?

Urethrocutaneous fistulas are unwanted openings between the urethra (where a person’s urine comes out) and the perineum (the skin in the groin area). They can cause urine to leak out, which is embarrassing and unsanitary. They also can lead to infections in the urinary tract, which can be damaging to organs and tissue in that area.

Urethrocutaneous fistulas are rare and can be present at birth or can develop as a result of an infection, an injury, or as a complication after surgery on or near the urethra.

Diagnosis and Tests

How is a urethrocutaneous fistula diagnosed?

There are several tests that a healthcare provider can order to confirm if a problem, such as urine leaking out or an otherwise-unexplained infection in that part of the body, is a urethrocutaneous fistula. These include:

  • Voiding cystourethrogram, or VCUG, is a test in which dye is injected into the bladder and then the patient is asked to urinate while on the exam table to allow physicians to see where urine goes when it leaves the bladder. For example, it may flow upward toward the kidney.
  • Retrograde urethrograms or fistulograms, also involve inserting a catheter into the bladder and injecting a small amount of dye, and then monitoring where the dye goes. This test can help show the location and connections of unwanted openings.
  • Computed tomography, or CT scan, which uses X-rays and computers to produce images of the inside of the body, can help a doctor learn more about complications that may be related to a fistula, such as if it has led to the formation of an abscess (collection of infected fluid).

Management and Treatment

How are urethrocutaneous fistulas treated?

Although there are many variables to consider when making treatment decisions, such as size and location of urethrocutaneous fistulas, as well as the possibility that a patient has more than one fistula, surgery is usually needed to close them.

Smaller ones (less than 2 mm in size) are fairly easy to close. The surgeon simply stitches the opening shut while the patient is sedated.

Larger fistulas require more time and effort. If the skin around the fistula is not healthy, the surgeon may need to perform a more layered approach that is known as “waterproofing” to help seal off the opening.

Most patients will have a catheter placed during the procedure and for a short time afterward. They typically spend one night in the hospital after the surgery and then go home with bandages over the surgical area.

Outlook / Prognosis

How successful are urethrocutaneous fistula surgeries?

One study found that the overall success rate for fistula repair was 89 percent. For patients who did not have success the first time, doing a more complicated procedure on the second attempt (for example, treating a small fistula as you would normally treat a larger one) was very effective. Usually patients are advised to wait about six months before undergoing a second surgery, if needed, to allow the first procedure to heal completely.

Adding a “waterproofing layer” of skin is particularly effective when a second surgery is needed to correct ongoing problems.

Last reviewed by a Cleveland Clinic medical professional on 07/24/2018.

References

  • Srivastava R, Tandale M, Panse N. Management of urethrocutaneous fistula after hypospadias surgery—An experience of thirty-five cases. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3111134/) Indian Journal of Plastic Surgery. 2011 Jan-April;44(1):98-103. Accessed 8/20/2018.
  • Burivong W, Leelasithorn V, Varavithya V. Common lower urinary tract fistulas: A review of clinical presentations, causes and radiographic imaging. (http://www.ijcasereportsandimages.com/archive/2011/001-2011-ijcri/001-01-2011-burivong/ijcri-00101201111-burivong-full-text.php) International Journal of Case Reports and Images. 2011;2(1):1-7. Accessed 8/20/2018.

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