Urethro-cutaneous fistulas in men with spinal cord injury and neurogenic lower urinary tract dysfunction: A case series.

STUDY DESIGN Retrospective data analysis.

OBJECTIVE To investigate the diagnostic approach and therapeutic management of urethra-cutaneous fistulas (UCF) in people with spinal cord injury/disorder (SCI/D).

SETTING Specialized tertiary German center for spinal cord injury.

METHODS We retrospectively evaluated the data of SCI/D patients with UCF who were admitted for inpatient treatment from November 1st 2001 to August 31st 2025. A descriptive statistical analysis of the data was performed.

RESULTS Seventeen study participants were included; all were male with complete SCI/D according to AIS type A, with a median age at diagnosis of UCF of 61.0 years (IQR 52.0-67.0). Two people with spina bifida were included, while all others had traumatic SCI. The median latency period between the onset of SCI/D and the occurrence of UCF was 31.0 years (IQR 25.0-42.0). For bladder voiding, 11 study participants performed catheter-free reflex voiding using a urinary sheath (condom catheter), and 6 study participants performed intermittent self-catheterization (ISC). For the treatment of UCF, all patients underwent urinary diversion, 13 of them with suprapubic catheterisation. Eight patients were treated conservatively following catheter urinary diversion, while a total of 9 patients underwent surgery for UCF; 3 of them including cystectomy. Only three patients underwent urethral reconstruction, and an intact urethra allowing resumption of ISC could be achieved in 2 patients.

CONCLUSION The management of UCF in people with SCI/D remains a major challenge. Based on our experience, we present a management algorithm that should be evaluated in a larger, preferably multicenter study.