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CASE REPORT
Year : 2004  |  Volume : 20  |  Issue : 2  |  Page : 62-63
 

Congenital vasocutaneous fistula


Kolkata, India

Correspondence Address:
Dilip Kumar Pal
Vinayak Garden, Flat No.-A/3D, 41, Simla Road, Kolkata- 700 006
India
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How to cite this article:
Pal DK, Basuroy M. Congenital vasocutaneous fistula. Indian J Urol 2004;20:62-3

How to cite this URL:
Pal DK, Basuroy M. Congenital vasocutaneous fistula. Indian J Urol [serial online] 2004 [cited 2014 Nov 22];20:62-3. Available from: http://www.indianjurol.com/text.asp?2004/20/2/62/37176



   Case Report Top


An 18-years old male patient presented with a watery discharge from the left scrotum off and on since his childhood and vesical irritative symptoms for last few days. On examination the epididymis of the left side was tender and swollen with a normal testis and there was discharge of pus from a fistulous opening from the posterior aspect of the left scrotum. Urinalysis suggested pus cells 40-50/H PE Pus culture from the discharge showed significant growth of  E.coli Scientific Name Search . USG of left scrotum showed a heterogeneous mass on the posterior aspect of the left testis and an enlarged epididymis. Uroflowmetry revealed a peak flow rate of 27m1/second. Retrograde urethrography showed reflux of contrast through the left vas deferens with an opening on the posterior aspect of the left testis [Figure - 1]. Cystoscopy demonstrated a prominent congested verumontanum, wide opened bladder neck and patulous left ejaculatory duct opening. After controlling the infection excision of epididymis and excision of vas with ligation of the proximal end at the level of the deep inguinal ring was done through an inguinoscrotal incision. Retrograde urethrography did not revel any reflux through the vas deferens at 6 months follow up. The patient is on regular follow up for 3 years without any recurrence.


   Comments Top


Vasocutaneous fistula on the scrotum is rare and they occur following scrotal vasectomy, orchidetomy and scrotal trauma [1],[2],[3] A careful review of the literature revealed only 16 cases since Young documented first case in 1926 [2] . Only one of the previously reported cases was congenital and all other cases were acquired [3] . Most of the cases have been associated with bladder outflow obstruction leading to retrograde flow of urine through vas deferens due to high intravesical pressure with an ultimate result of fistula [2],[3] . It has not been definitely established that reflux of infected urine into the vas deferens has a contributory role in the development of epididymitis or wheather it is just a coincidental finding [1],[5],[6] Infection may also reach the epididymis by the blood stream, along the lymphatic of the spermatic cord and along the sheath of the vas deferens [5],[6] . In the present case no infravesical obstruction was detected on cystoscopy. In the congenital fistula reported by Hartway the ejaculatory duct had a caliber of 5F and the opening was patulous [3] . Retrograde urethrography or micturating cystourethrography or fistulography helps to identify the course of the fistula. The management has been local excision or vasectomy [3],[4] . Recurrence of fistula has not been reported any of the previously described cases [3].

 
   References Top

1.Cobb OE, Lane FC, Anderson EE. Vasocutaneous fistula. J Urol 1966; 95: 788-790.  Back to cited text no. 1  [PUBMED]  
2.Thomas RB, Wisniewski ZS. Cutaneous fistula to the vas deferens. J Urol 1992; 147: 472-473.  Back to cited text no. 2  [PUBMED]  
3.Hawtrey CE. Case report of a congenital urethro-vasocutaneous fistula. J Urol 1970; 104: 555-556.  Back to cited text no. 3  [PUBMED]  
4.Nurmi M, Nelimarkka 0. Bilateral vasocutaneous urinaryfistula. BrJ Urol 1988;61: 96.  Back to cited text no. 4    
5.Assimos DG, Basile JJ, Boyce WH. rethrovasocutaneous fistula. Urology 1988;31:338.   Back to cited text no. 5  [PUBMED]  
6.White EP, Berry NE. Urinary fistula of the vas deferens. Cand Med Asso J 1956;75:301.  Back to cited text no. 6    


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