A fistula is defined as an abnormal tube-like pathway from a normal cavity or tube to a free surface or another cavity. In this case, the fistula is present in the urethra.

Fistulas may result from congenital anomalies, abscesses, injuries, or inflammatory processes. Acute injuries, e.g., gunshot wounds, are the most common cause.

Early signs and symptoms of trauma to the urethra may not be specific. However, urinary leakage, obstruction, lack of urine, and sepsis may occur, as well as pneumaturia (passing of gas with urine). In addition, hematuria occurs in approximately 30% of patients.

Diagnosis may be made through exploratory surgery or intravenous urography.

Fistulectomy is usually the treatment of choice for most fistulas. Alternative treatments include grafts, coils, or plugs.

It is essential to obtain an early diagnosis, and to institute treatment to avoid complications and safeguard renal function.

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Total plus 60% and – Special Monthly Compensation (SMC)

• When evaluating any claim involving loss or loss of use of one or more creative organs, refer to 38 CFR 3.350 of this chapter to determine whether the Veteran may be entitled to special monthly compensation. Footnotes in the schedule indicate conditions which potentially establish entitlement to special monthly compensation; however, there are other conditions in this section which under certain circumstances also establish entitlement to special monthly compensation.