Urethro-scrotal fistula presenting as massive scrotal "bladder" on radionuclide bone scan
Bohnen, N.J.; Shapiro, B.
Clinical Nuclear Medicine 22(12): 864-865
1997
ISSN/ISBN: 0363-9762 PMID: 9408659 Document Number: 475071
A 74-year-old man underwent Tc-99m MDP bone scintigraphy for evaluation of rheumatoid arthritis. Tc-99m MDP images demonstrated a large area of sharply demarcated, abnormally increased activity in the scrotal region and mildly increased tracer uptake in both knees and right ankle. Physical inspection revealed a very large, fluid-filled scrotum. The patient had sustained a pelvic fracture nearly 40 years earlier. This resulted in a prostatomembranous urethral disruption with subsequent unsuccessful attempts at repair. Recent urethrocystoscopic examination revealed a ventral urethral opening with passage into a capacious scrotal pouch, which was epithelialized. The patient had also been treated for recurrent urethral strictures. The patient normally voided by emptying his bladder into the scrotum and then manually decompressing the scrotum to void the urine via the urethra. This represents a different mechanism from previous reports of inguinoscrotal bladder herniation.