Urethrocavernous fistula: a case report and systematic review

Urethrocavernous fistulas are rare pathological communications between the urethra and corpora cavernosa, primarily associated with trauma or iatrogenic interventions (e.g., priapism shunt surgery). Their nonspecific symptomatology (urethrorrhagia, purulent discharge, or urinary retention) often delays diagnosis. The objective of this paper is to analyze the clinical and therapeutic profile of urethrocavernous fistulas through a case report and systematic literature review to establish evidence-based management insights.

A 22-year-old male presented with recurrent urethrorrhagia during erection and acute urinary retention secondary to clots. The initial urethroscopy and CT angiography were inconclusive. Subsequent arteriography revealed a right internal pudendal artery-cavernosal fistula. After two non-permanent embolizations failed, definitive occlusion was achieved via non-absorbable coils, resolving symptoms without recurrence or other complications at 23 months.

Urethrocavernous fistulas are rare with limited literature descriptions. Systematic review of 17 cases reveals marked heterogeneity in the clinical presentations and the therapeutic outcomes, emphasizing the imperative for standardized diagnostic and therapeutic protocols. They are predominantly diagnosed incidentally through retrograde urethrography and urethroscopy. Conservative management with urinary diversion may be considered as the initial approach, while surgery is reserved for refractory cases or those with associated injuries. Embolization is a poorly studied treatment option.