Urethrocavernous fistula: a case report and systematic review

Fístula uretrocavernosa: un reporte de un caso y una revisión sistemática

Background: 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. Case: 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. Conclusions: 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.

Resumen

Antecedentes: Las fístulas uretrocavernosas son comunicaciones patológicas infrecuentes entre la uretra y los cuerpos cavernosos, asociadas principalmente a traumatismos o intervenciones iatrogénicas (ej. cirugía de derivación para priapismo). Su sintomatología inespecífica (uretrorragia, secreción purulenta o retención urinaria) suele retrasar el diagnóstico. El objetivo de este artículo es analizar el perfil clínico-terapéutico de estas fistulas mediante un reporte de caso y una revisión sistemática de la literatura, con el fin de establecer pautas de manejo basadas en evidencia. Caso: Varón de 22 años presentó uretrorragia recurrente durante la erección y retención urinaria aguda secundaria a coágulos. La uretroscopia y la angiografía por tomografía computarizada (TC) iniciales fueron inconclusas. Una arteriografía posterior identificó una fístula entre la arteria pudenda interna derecha y el cuerpo cavernoso ipsilateral. Tras el fracaso de las dos embolizaciones temporales con material absorbible, se logró la oclusión definitiva mediante coils no absorbibles, resolviendo los síntomas sin recurrencia ni complicaciones a los 23 meses. Conclusiones: Las fístulas uretrocavernosas son entidades raras con escasa descripción en la literatura. La revisión sistemática de 17 casos reveló una heterogeneidad destacable en sus presentaciones clínicas y resultados terapéuticos, subrayando la necesidad de protocolos diagnósticos y terapéuticos estandarizados. Su diagnóstico es predominantemente incidental mediante uretrografía retrógrada y uretroscopia. El manejo conservador con derivación urinaria puede considerarse como abordaje inicial, reservándose la cirugía para casos refractarios o con lesiones asociadas. La embolización constituye una opción terapéutica poco estudiada.

Urethrocavernous fistula; Retrograde urethrography; Trauma; Surgery; Conservative management

Palabras Clave

Fístula uretrocavernosa; Uretrografía retrógrada; Traumatismo; Cirugía; Tratamiento conservador

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