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Recurrent vesico-acetabulo-cutaneous fistula: lessons to be learnt
  1. Pankaj Wadhwa1,
  2. Sunny Goel1,
  3. Harkirat Singh Talwar2 and
  4. Feroz Zafar2
  1. 1Department of Urology, Medanta The Medicity Medanta Institute of Kidney and Urology, Gurugram, Haryana, India
  2. 2Medanta The Medicity Medanta Institute of Kidney and Urology, Gurugram, Haryana, India
  1. Correspondence to Dr Pankaj Wadhwa; drpwadhwa{at}


A man in early 40s met with an accident with a complex pelvic fracture and extraperitoneal bladder injury and posterior urethral disruption 16 years ago. He additionally had left lumbar spinal segment mixed nerve injury, resulting in a foot drop. He underwent laparotomy and a diverting cystostomy at the time with a primary perineal urethroplasty a year later. He later developed pseudoarthrodesis of the hip joint, and poorly compliant bladder with complete block at bulbar urethra. A redo anastomotic urethroplasty was performed, hyperreflexive neurogenic bladder was managed with intravesical botox injections and underwent a hip replacement. Having defaulted botox injections, he developed a vesico-acetabulo-cutaneous fistula and the hip prosthesis was explanted. Later he underwent a ileal cystoplasty and a revision hip replacement. Ten years later, he presented with a recurrent fistula due to poor compliance with clean intermittent catheterisation. A challenging exploration with fistula excision was done with a primary bladder repair.

  • Hip prosthesis implantation
  • Urology

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  • Contributors PW: Manuscript preparation, editing, final approval. SG: Data collection and refinement. HST: Manuscript editing and images. FZ: Intellectual content and manuscript editing.

  • 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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