# Urethrocavernocutaneous Fistula in a Patient With an Inflatable Penile Prosthesis Following Urethral and External Catheter Trauma: A Case Report

## TL;DR

A rare case of a fistula in a man with a penile implant highlights risks of catheter use and infection in patients with pre-existing health conditions.

## Contribution

This is the first reported case of a urethrocavernocutaneous fistula complicating an inflatable penile prosthesis.

## Key findings

- A 70-year-old man with an inflatable penile prosthesis developed a fistula due to catheter trauma and co-morbidities.
- The infection was complicated by the presence of Nakaseomyces glabratus and required device removal and urinary diversion.
- The case emphasizes the need for careful catheter management and early recognition of penile implant complications.

## Abstract

We report a case of urethrocavernocutaneous fistula in a 70-year-old man with a long-standing inflatable penile prosthesis (IPP), attributed to traumatic urethral catheterisation and external pressure injury from an external (conveen) catheter. His significant co-morbidities, including type 1 diabetes mellitus and peripheral vascular disease, likely contributed to impaired tissue healing and susceptibility to infection. During a medical admission, he developed a penile infection with purulent discharge from the glans and mid-shaft and a draining sinus at the previous infrapubic incision. MRI demonstrated peri-prosthetic fluid collections and a 7 × 4 cm abscess, while intraoperative findings confirmed a urethrocavernocutaneous fistula. The device was explanted, and urinary diversion was established via suprapubic and urethral catheters. Cultures grew Nakaseomyces glabratus, adding further complexity to the infection. This case illustrates the serious risks of both urethral and external catheter use in patients with IPPs, particularly those with significant co-morbidities. This case underscores the importance of recognising the presence of an IPP early, carefully weighing the need for catheterisation in such patients, ensuring prompt surgical management of infection, and developing clearer guidance on catheter use to minimise avoidable morbidity and device loss. To our knowledge, this represents the first reported case of a urethrocavernocutaneous fistula complicating an IPP, highlighting its rarity and clinical significance.