A fistula may develop between the ureter and the skin surface.


Risk factors:

(1) surgery (usually abdominal or pelvic but may include hip replacement)

(2) xanthogranulomatous pyelonephritis

(3) nephrolithiasis

(4) penetrating trauma


The patient develops a cutaneous opening on the lower back, flank or abdomen that drains urine. This may be a little or a lot.


The presence of urine can be confirmed by measuring the fluid's creatinine which should be much higher than that seen in the serum.


Imaging studies may:

(1) demonstrate the connection using a contrast material (excretory urography, etc)

(2) show pneumonephrosis


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