Images in Clinical Urology

Prostato-cutaneous Fistula: A Rare ClinicalEntityNiraj Kumar, Pawan Vasudeva, Anup Kumar, and Punita Raheja

A 30-year-old man presented with intermittent leak of straw-colored fluid from his left lateral thigh, which on eval-uation was diagnosed as prostatocutaneous fistula. Exploration and revision anastomotic urethroplasty was done and thepatient remains asymptomatic in follow-up. UROLOGY 82: e9ee10, 2013. � 2013 Elsevier Inc.

Figure 1. Left lateral thigh demonstrating multiple fistulous openings.

Figure 2. (A) X-ray of the pelvis demonstrating septic arthritis of the left hip. (B) Fistulogram demonstrating prostatocuta-

30-year-old man presented with intermittentleak of straw-colored fluid from his left lateral

neous fistula.

Athigh occurring for the past 18 months. He hadundergone anastomotic urethroplasty for a pelvic fracture

Financial Disclosure: The authors declare that they have no relevant financial interests.From the Department of Urology, V.M. Medical College and Safdarjang Hospital,

New Delhi, IndiaReprint requests: Niraj Kumar, M.S., Department of Urology, V.M. Medical

College and Safdarjang Hospital, New Delhi 110029, India. E-mail: drniraj79@gmail.comSubmitted: March 19, 2013, accepted (with revisions): April 19, 2013

ª 2013 Elsevier Inc.All Rights Reserved h

urethral distraction defect 12 years ago and was under-going yearly urethral dilatation thereafter. The leak(initially from a single opening, but over the monthsmultiple openings had formed) started 3 months after thelast urethral dilatation, which was traumatic. Examina-tion revealed multiple openings with associated scarringof skin over the left lateral thigh (Fig. 1). Radiologicalevaluation showed a prostatocutaneous fistula (PCF) withseptic arthritis of the left hip joint (Figs. 2 and 3). Biopsyfrom the fistulous tract revealed chronic inflammatoryinfiltrate. Initial conservative management failed and the

0090-4295/13/$36.00 e9ttp://dx.doi.org/10.1016/j.urology.2013.04.023

Figure 3. Computed tomography fistulogram demonstrating prostatocutaneous fistula. (A) Anterior view. (B) Posterior view.(C) Oblique anterior view. (D) Oblique posterior view.

patient underwent exploration, excision of diseased tissue(including portion of prostatic urethra), and revisionanastomotic urethroplasty with omental interposition. Atthe 12-month follow-up, the patient is asymptomatic.

Until this date, only 3 cases of PCF have been re-ported, all extending into the medial thigh/perineum.The 3 reported PCFs were complications of open pros-tatectomy,1 channel transurethral resection of the pros-tate,2 and surgical intervention for neurogenic bladder,3

respectively. To our best knowledge, this is the firstreport of a PCF extending into the lateral thigh. Theetiology is unclear, although it may have resulted from

e10

a urethral dilatation gone wrong with a subsequentinfection complicating matters.

References

1. Snooks SJ, Dharmasena F, Mitchell TJ, Crisp JC. Prostatocutaneousurinary fistula to the thigh after retropubic prostatectomy in a patientwith polycythaemia rubra vera. Br J Urol. 1986;58:558.

2. Price AJ, Bates TS, Deveraj V, Stott MA. An unusual prostatocu-taneous fistula. Br J Urol. 1997;80:509-510.

3. Yohannes P, Khan A, Francis K, Sudan R. Robot-assisted Brickerileoureteral anastomosis during intracorporeal laparoscopic ilealconduit urinary diversion for prostatocutaneous fistula: case report.J Endourol. 2004;18:269-272.

UROLOGY 82 (2), 2013