URETHRO-CAVERNO-CUTANEOUS FISTULA WITH DISTAL URETHRAL STRICTURE AND ABERRANT VOIDING INTO CORPORA CAVERNOSA M. J. REDDY, M.S. V. N. BHAT, M.S. K. M. K. RAO, M.S. S. VAIDYANATHAN, M.S. M. S. RAO, M.S.. C. L. GUPTA, M.S. B. C. BAPNA, F.R.C.S. (C) From the Department of Surgery, Division of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCB ABSTRACT - Following emergency cavernospongiosum shunt performed for priapism occurring in a psy chiatric patient on chlorpromazine therapy , a urethro- caverno- cutaneous jistula with distal urethral stricture developed, resulting in aberrant voiding into the corpora cavernosa. The causation, management, and prevention of this hitherto unreported combination are discussed. Priapism is a surgical emergency. Generally, medical treatment is unsuccessful, and the consequent delay in surgical intervention re- sults in impotency most often. In recent years the cavemospongiosum shunt has become more popular than the cavemosaphenous shunt be- cause of simplicity of technique and comparable success rate. In 1972 Klugo and Olsson’ re- ported a case of urethrocavernous fistula follow- ing cavemospongiosum shunt, managed success- fully with suprapubic urinary diversion alone. In the same year Fortuno and Carrillo2 reported a case of gangrene of the penis following caverno- spongiosum shunt. In our patient after emer- gency bilateral cavernospongiosum shunt, a urethro-caverno-cutaneous fistula developed which resulted in aberrant micturition into the corpora cavernosa. Case Report A thirty-five-year-old engineer, a bachelor, with a ten-year history of schizophrenia was brought to the emergency room with com- plaints of persistent painful erection of the penis for seventy-two hours. Prior to seeking uro- logic advice, various modes of treatment were tried, including sedatives, anticoagulants, and UROLOGY / JUNE 1980 / VOLUME XV, NUMBER 6 masturbation which did not give him any relief. He was on chlorpromazine therapy (200 mg. daily) for the past ten years. Physical examina- tion of the patient confirmed priapism. Systemic examination of the patient was noncontributory. Results of hemogram including peripheral smear and platelet count were normal. Sickle cell trait and leukemia were excluded by various hematologic investigations. The following were normal: blood urea, blood sugar, serum electrolytes, urinalysis and urine culture, x-ray film of chest, and electrocardiogram. Within six hours after admission, under general anes- thesia, the corpora were irrigated with heparin- saline solution. Bilateral cavernospongiosum shunts had to be performed before complete detumescence of the penis could be achieved. A zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFE 16 F urethral Foley catheter was left in- dwelling for forty-eight hours. The initial post- operative period was uneventful The penis re- mained flaccid, and the patient was able to pass urine freely per urethra after removal of the catheter. On the ninth postoperative day after the perineal sutures had been removed, the patient noticed the penis becoming turgid and painful during voiding. At the end of micturition, 593