Do you also experience urine leakage from somewhere else? Let's learn about this urethrocutaneous fistula!

Have you ever felt like you were leaking urine from somewhere other than normal? Or do you get frequent urinary tract infections (UTIs)? Although these are things we sometimes don't pay much attention to, the underlying condition is called Urethrocutaneous Fistula. Don't worry, we'll talk about this in a simple way that you can understand.

What is this urethrocutaneous fistula?

Simply put, this is a bit of a complicated name, but it's not difficult to understand. Let's first understand these words.

• Urethra: The urethra is the tube that carries urine (also called pee ) out of your body. It's like a water pipe.
• Cutaneous: This refers to something related to the skin .
• Fistula: A fistula is an abnormal connection, culvert, or tunnel between two internal parts of the body or between an internal part and the surface of the skin.

Then, a urethrocutaneous fistula is a new, unnatural passageway that forms from your urethra to the skin around your genitals or the skin between your anus and genitals (which we medically call the perineum). Think of it like a hole in a water pipe that leaks water from somewhere else.

Normally, urine should only pass through the urethra and exit the body. But because of this fistula, urine starts to pass through that new path and exit through that new hole on the skin surface. This is also called a urinary fistula or urethral fistula .

This condition is considered a bit serious because it will not heal on its own. It will definitely need to be corrected with surgery . If not, it can lead to more frequent urinary tract infections (UTIs) and other problems.

What are the symptoms of this? How do you know?

There are several key symptoms that may indicate you have this condition:

• Leaking urine from the newly formed hole (fistula): This is the main and most obvious symptom. Not only when urinating, but sometimes even when standing. We also call this urinary incontinence , which means not being able to control urine.
• Frequent urinary tract infections (UTIs): This unnatural route allows germs to easily enter the urinary tract and cause infections. This can also damage surrounding organs and tissues.

If you have symptoms like these, it's best to definitely see a doctor and get checked out.

Why is this happening? What are the reasons?

There are several main reasons why a urethrocutaneous fistula develops.

• As a complication of previous surgery: This is the most common cause. This type of fistula can develop, especially after surgery for a condition called hypospadias .
• What is hypospadias? Simply put, it's a condition that boys are born with. It means that the opening for urine is located on the underside of the penis, rather than at the tip of the penis. So, after surgery to correct this, a fistula can sometimes develop as a side effect.
• Infection: Sometimes, due to an infection, pus can collect inside the tissue in that area and form an abscess . After this pus is treated and healed, a small, drain-like passageway may remain inside that tissue. That is what becomes a fistula.
• Injury: This can occur due to a hard blow to the affected area. For example, a mishit ball while playing cricket, a puck in a game like hockey, or a fall onto the crossbar of a bicycle (called a straddle injury ) can cause this condition.
• Rare causes: Very rarely, some children can be born with this condition. Also, people with poorly controlled diabetes mellitus (i.e., if their HbA1c level is above 8% for a year or more, despite regular treatment) are at risk of developing this fistula.

What are the risk factors for this?

Urethrocutaneous fistula is actually a very rare condition. However, the biggest risk factor for developing it is having had any previous surgery on your urethra.

For example:

• The surgery to repair the previously mentioned hypospadias.
• Urethroplasty (reconstruction of the urethra).
• Surgeries like circumcision .

This fistula can sometimes develop as a complication after such surgeries.

How do doctors diagnose this? (Diagnosis)

If you have unexplained urine leakage or unexplained urinary tract infections, a doctor may suspect a urethrocutaneous fistula. There are several tests your doctor may order to confirm the diagnosis:

• Voiding Cystourethrogram (VCUG): In this test, a doctor injects a special dye into your bladder. Then, you are asked to urinate on an examination table. The doctor can then see where the dye goes with your urine and if it leaks anywhere.
• Retrograde urethrograms or fistulograms: These are similar to VCUGs. They inject a dye into the bladder to clearly see where the urethra is, where the fistula is, and how it is connected.
• CT scan (Computed Tomography - CT scan): A CT scan uses X-rays and computer technology to take detailed pictures of the inside of the body. This can help doctors see if there are any other complications from the fistula, such as an abscess.
• Cystoscopy: This involves inserting a long, thin, lighted instrument called a cystoscope into your urethra. This allows the doctor to see inside your urethra and see exactly where the fistula is and what it looks like.

What are the treatments for this? Can it be cured?

Yes, this condition can be treated. Most often, it requires surgery. But before starting treatment, the doctor will consider several factors. Here are some of them:

• The size of the fistula.
• Where it is located (Location).
• Is there more than one fistula (Possibility of multiple fistulas) .

The treatment method is determined based on these factors.

• Smaller fistulas (< 2mm) are relatively easy to close. The doctor will give you a sedative to relax you and make you sleepy, and a surgeon will stitch the fistula closed.
• Larger fistulas require a more complex surgery. Sometimes, if the skin around the fistula is not healthy, the surgeon may need to use a multi-layered approach. This means that healthy skin from another part of your body (called skin flaps ) is taken to replace the damaged tissue, and a waterproofing layer is used to seal the hole.

Many people will need to use a urinary catheter to drain urine from their bladder for a few days after surgery. This helps the newly repaired area heal. You may also need to stay in the hospital for a day or so after surgery.

Will this fistula heal on its own?

No, a urethral fistula will not heal on its own.Many people will definitely need surgery to close this. This can only be treated by a urologist , a doctor who specializes in diseases related to the urinary system and reproductive system.

How long does it take to recover after surgery?

This is hard to say for sure. Everyone's body is different, so the healing time can vary from person to person. But usually, the swelling and bruising that occurs after surgery will subside in a few weeks. Doctors say that you should be completely healed in about six weeks . It is very important to follow your doctor's instructions exactly during that time.

Can this situation be prevented from occurring?

In fact, we cannot prevent all the causes that contribute to the development of urethrocutaneous fistula. For example, it is difficult for us to control one that develops as a complication of surgery.

However, you can do these things to prevent injury to that area:

• When playing sports or doing other rigorous activities, wear an athletic cup , also known as a jockstrap. Make sure it's the right size for you.
• Always wear your seatbelt when driving or as a passenger in a car.
• Be safe when riding a bike. If possible, attach something like a pannier rack to the crossbar of your bike. This can help reduce the risk of injury in the event of an accident.

What happens if I have a urethrocutaneous fistula? Should I be worried?

It's normal to feel a little scared when you find out you have a urethrocutaneous fistula. But the best part is, there are treatments for it, and with treatment, the overall recovery rate is very good.

One study found that fistula repair surgery is 89% successful. That means that out of ten people who have surgery, about nine will have a complete recovery. Sometimes, if symptoms persist after the first surgery, a more complicated layered approach can be performed. This is also very successful. However, if you have a second surgery, you will need to wait at least six months after the first surgery to allow the area to fully heal.

When should I see the doctor?

After having surgery to repair a urethrocutaneous fistula, it is very important to keep regular appointments with your doctor to make sure you are healing properly. Be sure to keep your appointments as your doctor tells you. This way, he or she can monitor your condition. If your symptoms are still present, he or she may recommend another surgery.

When should you go to the Emergency Treatment Unit (ETU) ?

After surgery, if you have any of the following symptoms, you should go to the nearest Emergency Room (ER) immediately:

• If there is excessive bleeding from the surgical site.
• If you have a fever of 100 Fahrenheit (38 Celsius) or higher .
• If the pain becomes unbearable .
• If you have difficulty urinating, or if your urine seems to be blocked.
• If there is blood in the urine (Hematuria).

Also, if your catheter comes out on its own, or if urine leaks from around the catheter, it's a good idea to see a doctor immediately.

What are the important questions to ask your doctor?

When you go to see your doctor, you have the right to ask questions like these. These will help you get a better understanding of your condition:

• How do you know for sure that I have a Urethrocutaneous Fistula?
• What could have caused this fistula?
• Do I have a small fistula or a large one?
• How should I take care of myself while I have this fistula? What should I do and what should I not do?
• What are the possible complications of this fistula repair surgery?
• Is it okay to have sex if I have a urethrocutaneous fistula? Will that cause a problem?

Don't be afraid to ask questions like these. Your doctor will explain everything to you.

Finally, take-home message:

Okay, so now we have a good understanding of what we have been talking about, Urethrocutaneous Fistula. The most important thing is that if you have any symptoms like this, such as urine leaking from somewhere else when you pass urine, or if you have frequent UTIs, don't ignore it. Sometimes it can be something minor, but it is always wise to seek medical advice as this can happen.

Remember, there is treatment for this, and treatment can be effective. So don't be afraid or embarrassed to see a doctor and discuss your concerns. We wish you a speedy recovery! You are not alone, and doctors are here to help.

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