G.U. Recon Mang Chen MD  2019  

G.U. Recon Clinic

45 Castro St. Ste 111

San Francisco, CA 94114

Office: 415-481-3890

Fax: 309-328-3827

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Urethral Fistulas & Strictures

FISTULAS

  • Definition: a connection between the urethra and the outside skin (phallus, scrotum, and/or perineum).

  • Symptoms: urinary leakage from somewhere other than the tip of the phallus.

  • Fistulas are relatively common, and if present, are diagnosed when patients start urinating about 3 weeks postop. On occasion, fistulas develop beyond the 3 week period.

  • Phallus swelling increases your risk of a fistula on the underside of the phallus along the suture line.

    • Management: elevate the phallus, rest, wound care (ointment daily, keep clean), eat healthy​

    • Example: some patients don't have any fistulas during their first month of recovery, but then note new fistulas develop on the underside of the phallus. This occurs when patients have prolonged phallus swelling.

    • Swelling --> tension on a suture line --> higher chance of the suture line opening --> fistula

  • Risk factors for fistula formation:​

    • Smoking, poor nutrition​

    • Tension on the urethral suture line 

    • A urethral stricture (blockage of the urine flow can lead to upstream pressure buildup within the urethra; this may lead to a fistula and/or prevent a fistula from healing)

STRICTURES 

  • Definition: a narrowing of the urethra that obstructs the flow of urine.

  • Symptoms: weak stream, straining to urinate, occasional pain with large volume voids, feeling like the bladder is not empty, taking 60sec or longer to urinate to completion. If the stream progressively weakens over time, connect with your urologist sooner rather than later. If you wait too long, you may end up in acute urinary retention (inability to urinate with an uncomfortably and sometimes painful bladder filled with urine); this would require ER evaluation.

  • The most common locations of a stricture include the tip of the phallus urethra and at the connection between portions of urethral lengthening (example: between the phallus UL and minora UL)

  • Phallus swelling may act like a stricture as it compresses the urethra from the outside; swelling resolution will lead to improved voiding symptoms.

  • Strictures rarely, if ever, resolve on their own. They therefore require intervention.

    • Cystoscopy and urethral dilation​

    • Suprapubic tube and/or urethral catheter placement

    • Urethroplasty (offered about 3 months after surgery to allow the tissue to mature and become more vascular)

  • Risk factors for stricture formation:

    • Decreased blood flow:

      • The tip of the urethra is furthest away from the blood flow

      • The urethral connection between the phallus urethra and the minora urethra are subject to increased tension, which can lead to a decreased blood flow.

    • Smoking, poor nutrition​

  • Note: strictures and fistulas may sometimes occur together as they may derive from a similar cause, such as a decrease in blood flow.​

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