Urethrocutaneous fistula as a severe complication of treatment for priapism

Abstract

A 45-year-old white man had painful priapism after an operation for Achilles tendon rupture, performed under spinal anaesthesia. No causes of priapism, e.g. drugs, haematological disease or neurological disorders, were detectable. When the patient presented to us 48 h after surgery, cavernosal blood-gas analysis showed the presence of poorly oxygenated blood. Needle aspiration of the corpora was attempted unsuccessfully, and therefore irrigation with normal saline and an intracorporal injection with 50 mg phenylephrine was attempted, but it was not suf®cient to cause detumescence. A Winter procedure [1] was undertaken but with no signi®cant outcome. A large glans-cavernosal shunt, using the Al-Ghorab technique [2], was carried out. As even then there was no detumescence, because a high-¯ow mechanism was already present, bilateral superselective embolization of the cavernosal arteries was carried out using absorbable emboli. Two hours after this procedure the penis softened slightly and complete detumescence was attained within 10 h. In the next few days a small darkened spot < 2 cm in diameter appeared on the skin surrounding the meatus and the glandular urethra. One month afterward a meatal stenosis and two large urethrocutaneous ®stulae, near the coronal sulcus, developed (Fig. 1). The glans was shrunk and the corpora cavernosa hard and reduced in diameter and length, because of intense ®brosis. After 3-weekly selfdilatation for 6 months the patient had a suf®ciently good meatal calibre (18 F). The ®stulae were closed using à three-layer' microsurgical technique, overlapping a vaginal`blanket' on the sutures. One year after surgery the result was satisfactory, but the patient is impotent and awaiting insertion of a prosthesis.

Urethrocutaneous fistula post-Al-Ghorab shunt

“…Urethrocutaneous and urethro-caverno-cutaneous fistula cases have also been reported. 9 It is believed that the fistula may occur due to an inadvertent urethral injury 10 or to ischemia of the adjacent tissues. 9 In this case, besides the intraoperative urethral injury, the biopsy of the corpora cavernosa showed an area of necrosis.…”

Urethrocutaneous fistula after use of Tegress bulking agent: Case report and review of the literature

“…12,13 As such, providers must use caution in selecting a bulking agent, especially given the increasingly common trend of using these agents off label. 14 Reports of urethrocutaneous fistulas are rare in the literature: one associated with treatment for painful priapism 15 and another associated with a prostatic urethral calculus. 16 …”

High‐flow priapism complicating ischemic priapism following iatrogenic laceration of the dorsal artery during a Winter procedure

“…High-flow priapism as a complication of surgical treatment for low-flow priapism has been described previously. 4,5,11,12 Injury to the cavernosal arteries may occur during corporal aspiration 11 due to the fixity of arteries in the rigid edematous corpora, or during proximal shunting procedures connecting the crura with the corpus spongiosum. 5 In some cases, however, color Doppler sonography reveals a high-flow cavernosal arterial state without angiographic evidence of a cavernosal-sinusoidal fistula.…”

“…5 In some cases, however, color Doppler sonography reveals a high-flow cavernosal arterial state without angiographic evidence of a cavernosal-sinusoidal fistula. 4,12 In these patients, cavernosal artery embolization can be attempted to reduce penile inflow and intracorporal overpressure.…”