Urethrocutaneous Fistula: Understanding the Causes of Unwanted Urinary Tunnels
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer
A urethrocutaneous fistula is an unwanted opening connecting the urethra to the skin, usually noticed as urine leaking from somewhere other than the normal opening, such as the underside of the penis or perineum. Tests such as a VCUG, CT scan or cystoscopy map the tunnel. Treatment is usually surgery, with full recovery generally expected in about six weeks. [1]
What the research says
Repair works well, even for complex fistulas. A review of 1,092 hypospadias repairs found that a fistula developed in 66 patients, and 33 more were referred from elsewhere. Among 94 repairs using a skin flap for two-layer coverage, the overall failure rate was 6.4%. Simple closures covered with a flap failed in only 4.3% (3 of 69), and almost all repairs were done as outpatient procedures (Santangelo et al., Journal of Urology, 2003). [4]
The technique used for the original hypospadias repair matters. A meta-analysis of 12 randomized trials found that the Snodgrass (tubularized incised plate) technique had a significantly lower rate of urethrocutaneous fistula than the Mathieu technique (relative risk 0.48, 95% CI 0.30 to 0.77) (Borkar et al., Urologia, 2024). [2]
Circumcision can cause fistulas, and large ones are harder to fix. In 31 children treated for a post-circumcision fistula, 84% had been circumcised as newborns, and 81% of circumcisions were done by nurses without anesthesia. Fistula size ranged from 1.5 to 12 mm, and recurrence occurred in 8 patients (25%), all with large fistulas over 5 mm. The authors describe the condition as preventable (Ikuerowo et al., Nigerian Journal of Clinical Practice, 2014). [3]
Key Takeaways
Feature | Details |
Primary Definition | Abnormal tunnel between the urethra and genital or perineal skin |
Main Symptoms | Urinary incontinence and recurrent UTIs |
Leading Cause | Complications from previous surgery (such as hypospadias repair) |
Other Causes | Blunt force trauma, straddle injuries, infections, or (rarely) present at birth |
Diagnostic Tools | VCUG, fistulogram, CT scan, and cystoscopy |
Treatment Type | Usually surgery (simple repair or multi-layered flaps) |
Success Rate | About 89% for repair in one study cited by Cleveland Clinic |
Recovery Timeline | Full recovery in about 6 weeks |
Understanding Urethrocutaneous Fistula
The urinary system relies on a precise pathway: urine travels from the bladder through the urethra, where the urethra and sphincter muscles control its release. A urethrocutaneous fistula disrupts this system by creating a "shortcut" tunnel from the urethra to the skin of the genitals or the perineum (the thin layer of skin between the anus and the genitals). [1]
When this tunnel exists, urine follows the path of least resistance and can leak out of the body before it reaches the normal opening. The condition is also called a urinary fistula or urethral fistula. Because it bypasses the body's normal control, it can cause involuntary leakage and hygiene challenges. [1]
Symptoms and Warning Signs
The main sign of a urethrocutaneous fistula is urine leaving the body from an unusual location. The condition can also lead to infections. [1]
Common Indicators
Urinary Incontinence: Urine leaking from the fistula opening, often noticed on the underside of the penis or the perineal skin. [1]
Recurrent UTIs: The abnormal opening can let bacteria into the urinary tract, causing frequent urinary tract infections that can damage organs and tissues in the surrounding area. [1]
Skin Irritation: Constant exposure to urine can cause redness, soreness, and breakdown of the skin around the fistula.
Causes and Risk Factors
Some fistulas are congenital (present at birth), but most are acquired, meaning they develop later because of surgery, infection, or injury.
Surgical Complications
The most common cause is a previous surgery on or near the urethra. The greatest risk factor is having a procedure around the urethra, such as hypospadias repair (surgery to correct the position of the urethral opening), urethroplasty, or circumcision. [1]
Trauma and Infection
Injury: A blunt force to the groin, such as being struck by a baseball or hockey puck, or a straddle injury like falling onto a bicycle crossbar, can damage the urethra. [1]
Abscesses: An infection can cause a collection of pus (abscess). After the abscess clears, it can leave a tunnel behind in the tissue. [1]
Diabetes: In rare cases, mismanaged diabetes (an A1C above 8% for a year or more despite standard care) can lead to a fistula. [1]
Diagnosis and Clinical Testing
A provider may suspect a fistula if you have unexplained urine leakage or an unexplained urinary tract infection. Several tests can locate the tunnel and assess how complex it is. [1]
Diagnostic Procedures
Voiding Cystourethrogram (VCUG): Dye is injected into the bladder and you urinate on an exam table while X-rays are taken. This shows where the urine goes.
Retrograde Urethrogram or Fistulogram: Similar dye tests that show the location and connections of the fistula. [1]
CT Scan: Detailed images help identify complications, such as a pocket of pus. [1]
Cystoscopy: A urologist uses a thin, lighted scope (cystoscope) to look inside the urethra and bladder for a direct view of the fistula. [1]
Management and Surgical Repair
A urethrocutaneous fistula is a structural problem that will not heal on its own. Surgery is usually necessary to restore urinary control and prevent future infections, and a urologist treats it. [1]
The Surgical Process
The approach depends on the size and location of the opening and on whether there is more than one fistula:
Simple Repair: Small fistulas (less than 2 millimeters) are fairly easy to close. You receive a sedative and the surgeon closes the opening with stitches. [1]
Multi-Layered Repair: Larger fistulas, or those in areas with unhealthy skin, need a more involved approach. The surgeon may use flaps of skin from other areas to replace unhealthy tissue and create a "waterproofing" layer that seals off the opening. [1]
Recovery and Outlook
Most people need a urinary catheter to drain urine while they heal, and you may spend one night in the hospital. Swelling and bruising usually go away within a few weeks, and a full recovery takes about six weeks. [1]
The overall outlook is good with treatment. One study found a repair success rate of 89%. If symptoms continue, a follow-up surgery with a more complex layered approach is very effective, and you may need to wait at least six months after the first surgery to allow complete healing. [1]
Prevention Strategies
You cannot prevent every cause, but you can lower the risk of injury-related fistulas by:
When to Get Medical Help
Keep regular follow-up appointments after surgery so your provider can check your healing. Go to the nearest emergency room after a repair if you have heavy bleeding, a fever of 100 degrees Fahrenheit (38 degrees Celsius) or higher, increased pain, trouble peeing, or blood in your urine. It is also wise to see a provider if your catheter comes out or if urine leaks around it. [1]
Conclusion
A urethrocutaneous fistula can cause embarrassing and frustrating problems such as leakage and repeated urinary infections, but you do not have to live with them. Because the tunnel will not close by itself, a visit to a urologist is the first step. Surgery can close the opening and relieve symptoms, and with careful follow-up the outlook is good.
Frequently Asked Questions
What is a urethrocutaneous fistula?
It is an abnormal opening or tunnel that connects the urethra (the tube you pee through) to the skin of the genitals or perineum.
Can a fistula heal on its own?
No, these fistulas are structural tunnels that require surgery to close properly.
What is the most common cause?
The most common cause is a complication from a previous surgery, such as a hypospadias repair.
What are the main symptoms?
The primary symptoms are urine leaking from an unusual spot and frequent urinary tract infections (UTIs).
Is it painful?
The fistula itself may not be painful, but it can cause skin irritation and painful UTIs.
How do doctors find the fistula?
Doctors use imaging tests like a VCUG (where dye is used to track urine flow) and cystoscopy (looking inside with a scope).
What is a "straddle injury"?
It is an injury caused by falling onto an object with a leg on each side, such as a bicycle crossbar or a fence, which can damage the urethra.
Who treats this condition?
A urologist, or a pediatric urologist for children, diagnoses and repairs urethral fistulas.
How successful is the surgery?
One study found that the success rate for fistula repair is 89%.
What happens if the first surgery fails?
A follow-up surgery using a more complex, layered approach is usually very effective, typically performed at least six months after the first surgery.
What is a "waterproofing" layer in surgery?
It is a layer of healthy tissue, such as skin flaps, that the surgeon uses to seal off the opening and stop urine leaking through the repair.
Will I need a catheter after surgery?
Yes, most people need a urinary catheter for a short period to drain urine while the surgical site heals.
How long is the recovery period?
Full recovery generally takes about six weeks, though swelling and bruising usually go down within a few weeks.
Can children have this condition?
Yes, many cases are seen in children following surgeries to correct birth defects like hypospadias, or after circumcision.
Is it a common condition?
No, urethrocutaneous fistulas are rare.
Can an infection cause a fistula?
Yes, an infection can create an abscess (a pocket of pus) that leaves a tunnel behind once it clears.
Can diabetes play a role?
In rare cases, mismanaged diabetes (an A1C above 8% for a year or more despite standard care) can lead to a fistula.
What is the perineum?
It is the thin layer of skin between the anus and the genitals.
Does it affect sexual function?
Your surgeon can advise you. Cleveland Clinic lists this as a question to ask your provider, and activity is usually limited while the repair heals.
Can women get this?
Yes. The perineum includes the area near the vaginal opening, and urethral fistulas can occur in anyone, although they are more often discussed in male anatomy.
What is a VCUG?
A voiding cystourethrogram is an X-ray test that uses dye to see how urine flows through the bladder and urethra.
Can a fistula cause a fever?
A fever is usually a sign of a secondary infection, such as a UTI, which is common with fistulas. A fever of 100 degrees Fahrenheit (38 degrees Celsius) or higher after surgery needs emergency care.
What anesthesia is used for the surgery?
It depends on the repair. Small fistulas may be closed after a sedative, while larger repairs are more involved. Your surgical team will explain what is planned for you.
How can I prevent a traumatic fistula?
Wearing protective gear like athletic cups during sports and using seatbelts can help prevent the injuries that cause fistulas.
What is a fistulogram?
It is a diagnostic test where dye is used to show the location and connections of the fistula.
Can I go home the same day as surgery?
You may need to spend one night in the hospital for observation, depending on the repair.
Does it cause a bad smell?
Constant urine leakage can lead to hygiene issues and odors if not managed carefully.
Can a fistula be congenital?
Yes, in rare cases, babies are born with an abnormal connection between the urethra and the skin.
What is a urethroplasty?
It is a surgical procedure to repair or reconstruct the urethra. It is also listed as a procedure that can carry a risk of fistula.
Is there a non-surgical alternative?
Most people need surgery to close a urethral fistula, because it cannot heal itself.
Can I shower after surgery?
Your surgeon will give specific instructions, but usually you can shower after a few days once the initial healing begins.
What is hematuria?
It is the medical term for blood in the urine, which after a repair is a reason to seek emergency care.
How do I know if the repair worked?
The main sign of success is that urine no longer leaks from the abnormal opening.
Can multiple fistulas exist at once?
Yes, there can be more than one tunnel, which requires a more complex surgical plan.
Does it affect fertility?
A fistula itself does not typically affect fertility, though the surgeries involved are in the reproductive area.
What is a "blunt force" injury?
It is an injury caused by an impact with a dull object, like a baseball or a hockey puck, rather than a sharp cut.
Can a fistula be misdiagnosed?
It might be mistaken for general incontinence or a simple UTI until an exam and tests find the opening.
Is it more common in adults or children?
It is frequently seen in children after hypospadias repair or circumcision, but it can occur in adults after surgery, trauma, or infection.
What is a "layered approach" in surgery?
It uses flaps of healthy tissue in several layers to close the hole and create a stronger seal.
Can I play sports with a fistula?
You should limit strenuous activity until the fistula is repaired and you have fully recovered from surgery.
Does the skin around the fistula get damaged?
Yes, constant moisture from urine can break down the skin around the opening.
What is a cystoscope?
It is a thin, tube-like instrument with a lens and a light used to look inside the urinary tract.
Can a fistula cause kidney damage?
UTIs can damage organs and tissues in the surrounding area, and severe or repeated infections can reach the kidneys if they are not treated.
Is there a specific age for surgery?
Timing depends on the patient's health and the diagnosis, and your urologist will advise you.
What should I do if my catheter falls out?
Contact your urologist or care team right away. It is also wise to be seen if urine leaks around the catheter.
Can a fistula cause a "spray" when peeing?
Yes, urine may exit from both the normal opening and the fistula, causing an irregular stream.
Is it related to bladder cancer?
No, a urethrocutaneous fistula is a structural problem, not a cancer.
How do I keep the area clean before surgery?
Gentle, frequent cleaning and barrier creams may help protect the skin. Ask your provider what is best for you.
Can a fistula be caused by a catheter?
It is rare, but improper or traumatic catheterization can potentially damage the urethral lining.
What is the first sign I should look for?
The most obvious sign is urine leaking from a place other than the normal urethral opening.
Related Reading
Hypospadias Repair: Surgery, Recovery & Risks Explained covers the surgery after which urethrocutaneous fistulas most often form.
Hypospadias: Symptoms, Causes & Treatment Explained explains the birth difference of the urethral opening and its treatment.
Urethral Stricture: Symptoms, Causes, Diagnosis, and Treatment Explained describes narrowing of the urethra, which can raise fistula risk.
Fistula: Types, Symptoms, Causes, and Treatment Options explains the different kinds of fistulas and how they are treated.
References
Cleveland Clinic. Urethrocutaneous Fistula. Cleveland Clinic Health Library. Last updated July 29, 2024. https://my.clevelandclinic.org/health/diseases/17768-urethrocutaneous-fistula
Borkar N, Tiwari C, Nair A, et al. Snodgrass (tubularized incised plate) versus Mathieu repair of distal hypospadias: a systematic review and meta-analysis of randomized controlled trials. Urologia. 2024;91(4):842-851. PMID 39171667. https://doi.org/10.1177/03915603241273616
Ikuerowo SO, Bioku MJ, Omisanjo OA, et al. Urethrocutaneous fistula complicating circumcision in children. Niger J Clin Pract. 2014;17(2):145-148. PMID 24553021. https://doi.org/10.4103/1119-3077.127422
Santangelo K, Rushton HG, Belman AB. Outcome analysis of simple and complex urethrocutaneous fistula closure using a de-epithelialized or full thickness skin advancement flap for coverage. J Urol. 2003;170(4 Pt 2):1589-1592. PMID 14501668. https://doi.org/10.1097/01.ju.0000084624.17496.29
Disclaimer
This article is for informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
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