Circumcision in the Philippines is an essential part of Philippine tradition among prepubescent males. It is usually done by health care professionals. However, in other more geographically distant areas in the Philippines, traditional ways of circumcision, called pukpok, (English Translation: “To Pound”) are still being done. This case study describes a case of urethrocutaneous fistula as a complication in an 18-year-old Filipino male who underwent traditional circumcision using the pukpok technique.

Preoperatively, the patient was noted to have an opening at the ventral aspect of the subcoronal area of the glans. It was located superior to the urethral meatus (Figure 1). A large fibrotic skin tag was also noted superior to the fistula. The patient was diagnosed with a urethrocutaneous fistula. Intraoperatively, the fistulous tract was identified at the distal aspect of the penile shaft, approximately 1cm in length. The fistulous tract was then excised and anastomosis of the urethral ends was performed using vicryl 5-0 sutures over a French 16 siliconized Foley catheter (Figure 2).

Total operative time was 2 hours. The patient was sent home on the 5th postoperative day. On 1-month post-operative follow-up, the surgical wound has already healed. Repeat retrograde urethrogram showed unremarkable results. Foley catheter was then removed. Uroflowmetry on the 3rd postoperative month showed a Qmax of 16ml/sec.

Urethrocutaneous fistulas are uncommon and serious adverse events that may arise from male circumcision. It is frequently brought on by inexperienced individuals or personnel performing the procedure in unconventional settings outside of the medical field. Traditional approaches of circumcision, such as pukpok in the Philippines, may predispose an individual to various complications including urethrocutaneous fistulas. Its management requires excision of the fistulous tract followed by a simple anastomotic repair or substitution urethroplasty.