[Chronic perianal pyoderma with urethrocutaneous fistula: a case report]

Area of Science:

• Urology
• Dermatology
• Infectious Diseases

Background:

• A 65-year-old male presented with chronic perineal and gluteal skin fistulas with purulent discharge, a condition present for 50 years post-surgery.
• The patient had a history of spinal caries and renal tuberculosis, raising initial concerns for recurrent tuberculosis.

Observation:

• Physical examination revealed multiple fistulas with malodorous pus discharge, despite an intact anus.
• Urethrocystography identified bulbar urethral stenosis and a urinary leak proximal to the stenosis.
• Cultures from pus and urine isolated Staphylococcus spp., ruling out active tuberculosis.

Findings:

• The patient underwent cystostomy, debridement, resection, and mesh-skin grafting, followed by internal urethrotomy for urethral stenosis.
• The chronic fistulas were successfully managed, with no local recurrence or urinary difficulties observed post-surgery.
• The patient ultimately succumbed to cholangiocarcinoma three and a half years after the initial surgical management.

Implications:

• This case highlights a unique etiology of chronic perianal pyoderma originating from urinary tract fistulas, distinct from common causes like hemorrhoids or abscesses.
• It underscores the importance of thorough investigation into urinary tract abnormalities when evaluating chronic perineal fistulas.
• The successful surgical management demonstrates a viable treatment approach for this rare condition.