Urinary-cutaneous Fistulae in Patients With Neurogenic Bladder

To review our experience with neurogenic bladder (NGB) patients who developed urinary-cutaneous fistulae (UCF). Patients with NGB can form UCF of multiple etiologies; however, little is known about the characteristics or long-term outcomes of these defects.

We reviewed 21 patients with NGB who developed UCF between 1998 and 2013. The clinical end points of the study were development of UCF, fistula repair failure, and need for permanent urinary diversion. Possible risk factors associated with repair failures were examined.

We evaluated 21 patients with a mean age of 39.5 years (23-76) and median follow-up of 67 months (1-179). Causes of UCF included decubitus ulcers (7), wound infections or abscess formation (5), condom catheter complications (4), traumatic catheterization (4), and pelvic trauma (1). Thirteen patients had their fistulae repaired surgically, with 9 patients eventually requiring urinary diversion with a suprapubic (SP) tube (7) or ileal conduit (2) (9 of 13, 69%). Eight patients had their urine diverted upon presentation, with ileal conduit (5 of 8, 63%), SP tube (2 of 8, 25%), or perineal urethrostomy (1 of 8, 12%). In total, 17 eventually required permanent surgical or SP tube urinary diversion (81%), of which 9 were with an SP tube (53%), 4 with an ileal conduit (23%), 3 with a conduit catheter (18%), and 1 with a perineal urethrostomy (6%).

UCF repairs in patients with NGB are a challenge to manage. Patients who undergo surgical repair of their fistula are likely to require repeat repairs with eventual need for a permanent urinary diversion.