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Urethrocavernous Fistula: A Case Report
Vol.117,April Printed in U.S.A.
THE JOURNAL OF UROLOGY Copyright © 1977 by The Williams & Wilkins Co.
URETHROCAVERNOUS FISTULA: A CASE REPORT MARTIN BUCKSPAN*
AND
PHILIP KLOTZ
From the Department of Surgery, University of Toronto and Division of Urology, Mount Sinai Hospital, Toronto, Canada
ABSTRACT
A case of a urethrocavernous fistula treated by suprapubic cystostomy with subsequent complete closure is reported. DISCUSSION
Although effective in some cases the surgical treatment of idiopathic priapism is not without complications. Herein we describe a case of priapism, which resulted in 1 of these complications.
After a corporospongiosal shunt this complication can be treated by urinary diversion without a direct surgical approach to the fistula. To avoid this problem it would be advisable to place the shunt in the proximal bulbous urethra.
FIG. 1. A, retrograde urethrogram shows fistula extensively involving corpus (oblique view). B, urethrogram 1 month postoperatively shows residual sinus. CASE REPORT
A previously healthy 45-year-old man was admitted to the hospital 3 weeks after a cavernospongiosal shunt for idiopathic priapism. The operation was performed at another hospital. The patient complained of a continuous foul urethral discharge and failure of relief of the penile distension.· The shunt was performed in the region of the penoscrotal junction. Cystoscopy and urethrography revealed a 2 cm. fistulous opening between the urethra and the left corpus cavernosum (fig. 1, A). A suprapubic cystostomy was performed and the patient was instructed to express the penis manually. Within 1 week the penile edema and urethral discharge had decreased. A urethrogram 1 month later showed a small residual sinus (fig. 1, B). At 2 months postoperatively the penis was relatively normal, with some induration in the left corpus. At 3 months the patient was able to have a partial erection, involving the base of the penis only. The suprapubic tube was removed and a urethrogram 1 month later revealed complete closure of the fistula and no evidence of stricture (fig. 2). At 1 year following the original procedure the patient was still partially impotent but was able to void freely.
Accepted for publication November 24, 1976. *Requests for reprints: Department of Surgery, Mount Sinai Hospital, 600 University Ave., Toronto, Ontario, M5G 1X5.
FIG. 2. Urethrogram after removal of cystostomy tube with complete closure of abnormal communication and no stricture. 538
THE JOURNAL OF UROLOGY Copyright © 1977 by The Williams & Wilkins Co.
URETHROCAVERNOUS FISTULA: A CASE REPORT MARTIN BUCKSPAN*
AND
PHILIP KLOTZ
From the Department of Surgery, University of Toronto and Division of Urology, Mount Sinai Hospital, Toronto, Canada
ABSTRACT
A case of a urethrocavernous fistula treated by suprapubic cystostomy with subsequent complete closure is reported. DISCUSSION
Although effective in some cases the surgical treatment of idiopathic priapism is not without complications. Herein we describe a case of priapism, which resulted in 1 of these complications.
After a corporospongiosal shunt this complication can be treated by urinary diversion without a direct surgical approach to the fistula. To avoid this problem it would be advisable to place the shunt in the proximal bulbous urethra.
FIG. 1. A, retrograde urethrogram shows fistula extensively involving corpus (oblique view). B, urethrogram 1 month postoperatively shows residual sinus. CASE REPORT
A previously healthy 45-year-old man was admitted to the hospital 3 weeks after a cavernospongiosal shunt for idiopathic priapism. The operation was performed at another hospital. The patient complained of a continuous foul urethral discharge and failure of relief of the penile distension.· The shunt was performed in the region of the penoscrotal junction. Cystoscopy and urethrography revealed a 2 cm. fistulous opening between the urethra and the left corpus cavernosum (fig. 1, A). A suprapubic cystostomy was performed and the patient was instructed to express the penis manually. Within 1 week the penile edema and urethral discharge had decreased. A urethrogram 1 month later showed a small residual sinus (fig. 1, B). At 2 months postoperatively the penis was relatively normal, with some induration in the left corpus. At 3 months the patient was able to have a partial erection, involving the base of the penis only. The suprapubic tube was removed and a urethrogram 1 month later revealed complete closure of the fistula and no evidence of stricture (fig. 2). At 1 year following the original procedure the patient was still partially impotent but was able to void freely.
Accepted for publication November 24, 1976. *Requests for reprints: Department of Surgery, Mount Sinai Hospital, 600 University Ave., Toronto, Ontario, M5G 1X5.
FIG. 2. Urethrogram after removal of cystostomy tube with complete closure of abnormal communication and no stricture. 538