Multiple circumferential urethrocutaneous fistulae: a rare complication of circumcision

The complications of circumcision are wide ranging, urethrocutaneous fistula being one of the less common. This complication affects the ventral aspect of the penis and is usually solitary. We present a rare case of multiple fistulae after circumcision with two fistulae over the dorsal aspect of the penis. A 6-year-old male child presented with passage of urine from four openings. He had undergone a ritual circumcision by non-medical personnel. The urinary steam from the normally situated meatus was thin. The patient was passing urine mainly from the two openings which were situated on the dorsolateral aspect of the penis. On physical examination, there were three fistulous openings circumferentially over the corona, two over the dorsal aspect and one over the ventral aspect. During surgery a loop of linen thread was found eroding the urethra along with a constriction ring at the corona causing a 'tourniquet-like' effect. All three external urethral openings were combining to form a single urethral opening at the corona which itself occupied more than half of the urethral circumference. Resection of fistulae with anastomosis of the urethra was carried out. Postoperatively, the patient passed urine from a normal meatus with a good stream.