17768 Urethrocutaneous Fistula

Overview

A urethrocutaneous fistula is an abnormal tunnel that forms between the urethra (the tube that carries urine out of the body) and the skin. This tunnel lets urine leak out through the skin, often along the penis or scrotum, instead of only out the end of the penis.

No, it is not common. It occurs in a small number of children who have surgery for hypospadias, a birth condition where the opening of the urethra is not at the tip of the penis, and it is rare in adults.

It mostly affects boys and men. In children, it is often seen after surgery to correct hypospadias. In adults, it can affect anyone who has had trauma, infection, or surgery in the genital or pelvic area.

Symptoms

Common symptoms

• A small hole or opening on the skin of the penis or scrotum
• Leakage of urine from that opening, especially during urination
• A spray or double stream of urine
• Dampness or wetness around the opening

Symptoms in children

• The same visible hole and urine leakage
• Skin irritation or rash in the area because of constant wetness
• Crying or discomfort during urination
• In rare cases, difficulty urinating if the fistula is large

Symptoms in older adults

• Urine leaking from an unusual place, such as the lower belly, scrotum, or thigh
• A burning or stinging feeling if urine touches irritated skin
• Recurrent urinary tract infections with symptoms like pain or fever
• In some cases, blood in the urine

Causes

Main causes

• A birth defect where the urethra doesn't form normally, commonly related to hypospadias
• Complication after surgery to repair hypospadias or other penile surgery
• Trauma or injury to the penis, scrotum, or pelvic area
• Severe infection or abscess near the urethra
• Radiation therapy for pelvic cancers (rare)

Risk factors

• Having had hypospadias repair surgery
• Repeated urinary tract infections
• Long-term use of a urinary catheter (a tube to drain urine)
• Diseases that slow healing, such as poorly controlled diabetes
• Smoking or using tobacco, which affects blood flow and healing

When to see a doctor

See a doctor urgently if:

• If you cannot urinate at all
• If you have a fever and signs of a serious infection
• If there is heavy bleeding

Book a routine appointment if:

• If you notice new urine leaking from anywhere along the penis or scrotum
• If you have a persistent spray when urinating
• If you have a visible opening that weeps or leaks urine
• If you experience pain or burning during urination that doesn't go away

Diagnosis

Your doctor will listen to your symptoms, ask about your medical history, and examine the area. In many cases, the diagnosis is clear from the examination, but tests may be done to see the path of the fistula and plan treatment.

Tests that may be done

• Physical examination of the penis or scrotum, often while you are standing or lying down
• Voiding cystourethrogram (VCUG): an X-ray taken while the bladder is filled and you urinate, to see the fistula tract
• Urethroscopy: using a thin camera to look inside the urethra
• Ultrasound to see nearby structures

What to expect at your appointment

The visit is usually quick and not painful. Some tests, like a VCUG or urethroscopy, may be uncomfortable but are safe. Your doctor will explain each step and answer any questions. You may be referred to a urologist, a surgeon who treats the urinary tract, for further care.

Treatment

The main treatment for a urethrocutaneous fistula is surgery to close the abnormal opening and rebuild the normal pathway for urine. Sometimes a small fistula can close on its own with supportive care, but most need an operation. Your doctor or urologist will choose the best approach based on the size and location of the fistula.

Self-care at home

• Keep the area clean and dry to avoid skin irritation
• Change pads or dressings frequently if there is leaking
• Drink plenty of water to keep urine less concentrated
• Avoid activities that put pressure on the genital area, such as cycling, until you have seen a doctor

Medical treatments

Generally, medicines are not used to close a fistula, but if a urinary tract infection is present, your doctor may prescribe antibiotics. The definitive treatment is surgery. After surgery, a urinary catheter, a thin tube, is usually kept in place for a few days to keep the bladder empty while healing.

When is surgery considered?

Surgery is usually recommended for most fistulas, especially if they don't close on their own within several months. The procedure involves cutting out the fistula tract and closing the tissues in layers. It is often done as a day surgery or with a short hospital stay.

Living with this condition

Living with a urethrocutaneous fistula can be uncomfortable, but there are ways to manage. Wear absorbent pads or underwear liners to catch leaks. Clean the opening gently with warm water and pat dry. Avoid heavy exercise and anything that may irritate the skin until you have been seen.

Lifestyle tips

• Use pads or absorbent underwear to stay dry
• Wear loose-fitting, breathable cotton underwear
• Urinate frequently to avoid a full bladder and more leakage
• Practice good hygiene around the area to prevent skin breakdown
• If you smoke, ask your healthcare team for help quitting, as smoking slows healing

Diet and exercise

Eat a balanced diet with plenty of fruits and vegetables to support healing. Stay well-hydrated with water to keep urine dilute. Avoid strenuous exercise or heavy lifting until your doctor says it's safe.

Mental health and emotional wellbeing

Living with a fistula can feel embarrassing or stressful, especially if it affects intimate relationships or daily activities. These feelings are normal. Talking with your doctor, a counselor, or a support group can help. Remember that a fistula is not your fault and treatment is available.

Prevention

Not all fistulas can be prevented, especially those present at birth or after surgery. However, steps can be taken to reduce risk, such as treating urinary infections quickly, avoiding tobacco, and managing conditions like diabetes. If you are having surgery in the genital area, choosing an experienced surgical team lowers the chance of a fistula.

Vaccines

No vaccines prevent this condition.

Screening programmes

There is no routine screening for urethrocutaneous fistula. It is found because of symptoms or during a physical examination.

Complications

If left untreated

• Persistent urine leakage along the skin, causing skin breakdown and infection
• Recurrent urinary tract infections
• Narrowing of the urethra (stricture), making urination difficult
• In rare cases, an infection spreading deeper into the surrounding tissues

Long-term outlook

With the right treatment, the outlook is very good. Most fistulas are successfully closed with surgery, and urine returns to flowing normally. Healing takes a few weeks, but most people return to their usual activities. You can expect a full recovery with good follow-up care.

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