Tract lined with epithelium between the skin and the urethra.
Usually a complication of urethral surgery, or a result of periurethral inflammation related to a urethral stricture or treatment of a urethral tumour (including condylomata).
Treatment must be directed not only at the fistula, but also at the underlying disease process.
Principles of treatment:
- Endoscopic and radiological evaluation
- If fistula is small and urethral closure does not reduce urethral lumen:
- Fistula can be excised with surrounding skin
- Urethra closed with fine absorbable suture with inversion of mucosa, and then closure of layers without overlapping suture lines between skin and urethra.
- SPC diversion or IDC (?)
- If fistula is large enough that closure of urethra would compromise lumen:
- Local flap reconstruction may be required – dartos flap etc
- Even buccal grafts if required
Inflammatory strictures or processes combined with high pressure voiding may result in multiple fistulous tracts – watering can perineum.
- Suprapubic diversion
- Excision of all infected tissue and staged repair of stricture
Caution in men with complex fistulae but no history of previous strictures or urethral surgeries:
- Urethral cancer
- TB