Urethroscrotal Fistula: A Rare Cause of Scrotal Swelling

Abstract

SummaryBackgroundUrethroscrotal fistula (USF) is an abnormal communication between the urethra and the scrotum. This rare abnormality may be iatrogenic or secondary to perforation of the urethra by a stone. After the passage of urine to the scrotum through the fistula, painless scrotal swelling develops, which disappears completely with manual compression, and voiding can be maintained in this way. Retrograde urethrography (RU) and voiding cystourethrography (VCU) are traditional diagnostic methods, but they have limitations, such as technical difficulties and inability to evaluate the surrounding tissues. Multidetector CT (MDCT), together with reformatted images, can provide valuable information about the surrounding tissues and associated pathologies.Case ReportWe present a case of a 36-year-old male patient who had painless scrotal swelling after cystolithotomy and urethral stone surgery. The patient indicated that the swelling disappeared after manual compression. A fistula between the bulbous urethra and the scrotum was discovered by MDCT. In our case, we believe that the fistula developed iatrogenically during stone excision or secondary to perforation of the urethra by a stone.ConclusionsAs a rare pathology, urethroscrotal fistula should be considered in men with a history of urethral stone surgery and symptoms, including painless scrotal swelling, which can be manually compressed after voiding.

Scrotal calculi with delayed urethroscrotal fistula: a rare case presentation with literature review

“…7 Parlak et al also reported a case of uretheroscrotal fistula that developed after a surgery for uretheral stone removal and cystolithotomy, patient presented with painless scrotal swelling that used to disappear after manual compression, little bit similar as in our case fistula developed after scrotal stone removal but swelling didn't disappear on manual compression but demonstrated clear evidence of scrotourethral fistula as fluid was coming out both from scrotal skin and the urethral meatus (Figure 4), so we made a diagnosis of scrotourethral fisula on clinical basis only, unlike in prior case where they prescribed multidetector CT(MDCT) for the diagnosis. 8 Stizzo et al also reported a case of uretheroscrotal fistula associated with scrotal abscess, fistula developed because of wrong catheterization and because of this fistula scrotal abscess drained and helped in prevention from developing into fourneier's gangrene. 9 But in our case no scrotal abscess or any other symptoms found other than a scrotal swelling.…”

Scrotal abscess due to urethral fistula in spinal cord injured patient with prolonged indwelling urinary catheter

“…Urethral fistula is a rare occurrence in men. [ 1 2 ] They may be congenital or acquired, and possibly caused include infection, inflammatory disease, neoplasm, congenital condition, trauma and iatrogenic injury. [ 1 ] Paraplegic patient has a higher risk of urethral fistula due to prolonged urinary catheterizations.…”

“…[ 1 2 ] They may be congenital or acquired, and possibly caused include infection, inflammatory disease, neoplasm, congenital condition, trauma and iatrogenic injury. [ 1 ] Paraplegic patient has a higher risk of urethral fistula due to prolonged urinary catheterizations. [ 1 ] In a patient with paraplegia that treated with long-term catheterization, as in our case, we hypothesized that prolonged catheterization during the course of the primary disease, sensory disturbance and chronic immobilization might lead to pressure necrosis in the urethral wall and finally result in the formation of urethroscrotal fistula.…”

“…[ 1 ] Paraplegic patient has a higher risk of urethral fistula due to prolonged urinary catheterizations. [ 1 ] In a patient with paraplegia that treated with long-term catheterization, as in our case, we hypothesized that prolonged catheterization during the course of the primary disease, sensory disturbance and chronic immobilization might lead to pressure necrosis in the urethral wall and finally result in the formation of urethroscrotal fistula. With the presence of urine stasis and urinary tract infection eventually results in a scrotal abscess.…”

“…Urethral fistulas are rare in males[ 1 2 ] and can be congenital or acquired. [ 2 3 ] Scrotal abscess is one of the complications that can occur in the urethral fistula which needs proper treatment to prevent more serious complications.…”