Vesico-cutaneous fistula of the thigh as a late manifestation

Vesico-cutaneous fistulas rarely occur in the urinary tract (1.7% of all urinary fistulas). Trauma, neoplasias, inflammation and iatrogenic pathologies are among the principal causes. The external mouth of the fistula is usually found in the hypogastric area, scrotum, perineum and rarely elsewhere. This report describes the case of a 48 year old woman who, after severe trauma suffered bladder laceration, treated only with cystorraphy. Sepsis and gangrene followed involving the pubic area and the right thigh, associated with acute renal and adrenal gland cortex failure. After emergency treatment, the patient was discharged with an indwelling catheter. Ten months later she was referred to our urology clinic because of a suspected bladder-vaginal fistula. The indwelling catheter was removed and the bladder resumed functioning well. Six months later the external mouth of the fistula appeared on the right inner thigh. NMR confirmed the diagnosis of a vesico-cutaneous fistula. Surgery resolved the abnormality.