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Case report
Complex anal fistula involving male genital tract: a new diagnostic entity
  1. Abdullah Alahmari1,
  2. Majed Mansouri2 and
  3. Amjad Alwaal3
  1. 1 Department of Urology, King Abdulaziz University Faculty of Medicine, Jeddah, Saudi Arabia
  2. 2 Department of Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, Saudi Arabia
  3. 3 Department of Urology, Marshall University, Huntington, West Virginia, USA
  1. Correspondence to Dr Amjad Alwaal; amjadwal{at}


We present three male patients who had a rare presentation of anal fistula reaching the genital tract. Patient 1: a 44-year-old diabetic man presented initially to urology clinic complaining of penile and scrotal masses increasing in size for 6 months. Patient 2: a 67-year-old diabetic man presented with chronic sinus discharge from the scrotum. Patient 3: a 37-year-old diabetic man who presented with chronic sinus draining pus-like material from the scrotum for 1 year. Patients 1 and 2: following diagnosis of perianal fistula by MRI fistulography, complete excision of the fistula was done. This required tracking the fistula surgically, a perineal midline incision to release the fistula and excision of the fistula opening in the anal canal. The patients were doing well postoperative and no recurrence of fistula at 1-year follow-up. Patient 3: he refused surgical intervention. Penile mass or scrotal discharge has not been reported to be caused by fistula-in-ano.

  • urology
  • general surgery
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  • Contributors AbA: data collection and preparation of the manuscript. MM: patient care, surgery and preparation of the manuscript. AmA: patient care, surgery, data collection and preparation of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval The authors have obtained Research Ethics Committee approval from their institution.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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