A rare case of stricture urethra presenting as pyocele and urethrotunica vaginalis fistula.

To cite: Patil S, Goel A, Singh V, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2013202180 DESCRIPTION A 52-year-old man, with a known case of catheterinduced stricture urethra, presented with swelling and pain in the right scrotum with a high-grade fever for 8 days following an attempt of urethral stricture dilation using metallic bougie for urinary retention. On examination, he was found to have right epididymo-orchitis with pyocele. He underwent suprapubic catheter (SPC) placement and incision and drainage of pyocele. Retrograde urethrogram (after stabilisation of general condition) showed distal bulbar urethral stricture (1.5 cm) with extravasation of contrast in the right scrotum inside tunica vaginalis (figure 1). Urethroscopy showed stricture at the distal bulbar urethra with fistulous opening on the right lateral wall of the urethra distal to stricture (figure 2). A guide wire passed through scrotal end of the fistula was seen coming through urethral end of the fistula and then through the external urinary meatus (figures 3–5). The patient was discharged in satisfactory general condition with a plan of definitive management of stricture after resolution of the fistula. Perineum, rectum and genital structures are sites of fistulous communications with urethra. The literature is limited to a few case reports of urethra-scrotal fistula. 2 There is no report of fistulous communication between urethra and tunica vaginalis. Retrograde urethrography, voiding cystourethrography and cystourethroscopy are the main diagnostic modalities. Such patients are managed initially with temporary urinary diversion (SPC) followed by a definitive treatment of underlying causes if any.