Penoscrotal Extension and Fistulation From Urothelial Carcinoma of the Bladder

The commonest malignancy of the urinary tract is bladder cancer, with the commonest presentation being painless visible haematuria. Just like other malignancies, it can spread, commonly to surrounding tissues like the prostate, seminal vesicles, and vagina, distantly to lymph nodes, lungs, liver, and bone, and less commonly to the skin and subcutaneous tissues. This is a case of a man with muscle-invasive bladder cancer who underwent radical radiotherapy. He presented nine days into the course of his radiotherapy with new symptoms of pain, swelling, and discharge, particularly at the penoscrotal junction. Ultrasound scans of the testes were normal, and he was treated as a case of scrotal skin abscess with antibiotics. His symptoms persisted and worsened over time despite treatment and multiple hospital attendances. He developed a discharge of fluid from multiple sinuses in the area. Further cross-sectional imaging and direct visualisation with cystoscopy led to the conclusion that there was a urethral recurrence of his urothelial carcinoma which had extended locally into the soft tissues in the penoscrotal area and caused urocutaneous fistulous tracts. An extensive literature review showed no documented cases of vesicocutaneous fistula from urothelial carcinoma, making this the first reported case of penoscrotal extension of bladder cancer and fistulation after radiotherapy.