A urethral fistula could be either congenital or it may result of radiation injury, infection, trauma, surgery or rarely neoplasm. Fistulas may correspond with the skin, vagina, a pelvic organ such as bowel, or uterus, or one more segment of urethra. A fistula may be blind ending. Post traumatic fistulas will result if presence of superinfection or a more distal barrier causing rising pressures within the urethra. Urethroperineal fistulas are frequently the result of a periurethral abscess in men along with urethral strictures but it may also result from the surgery to repair hypospadias or correct a stricture.
Signs and symptoms may vary from every person, depends on the point of termination. For example, urethrocutaneous fistulas to the scrotum or perineum that may result in one or more openings that may leak urine during micturition, so termed as “watering pot” perineum.
Acute anterior urethral injury can be iatrogenic or result from blunt or penetrating injury; medical history generally includes mechanism of injury, blood at the meatus is the basic sign of anterior urethral injury, acquired diverticula can be caused by infection, trauma, and instrumentation it can involve any portion.
Urethral fistulas are generally imaged with voiding urethrography or retrograde, although vaginography fistulography, fluoroscopic studies of the small bowel or colon/rectum and MRI might be essential for diagnosis. Imaging should done to establish the number, location and size of fistulas. During urethrography lateral images descriptions of the lower pelvis are mainly essential. A fistula usually appears as an irregular tract that can be blind ending or communicating to other structure. The size and shape can be widely uneven.