Case of male accessory urethra with orifice in the scrotal skin

A 67-year-old male had an innate fistular orifice at the scrotal skin. In spite of occasional pus discharge from the orifice, no treatment had been performed for the fistula because it improved spontaneously. Due to increasing pus discharge, the fistula was resected at a dermatology clinic, but a persistent fistula tract was confirmed postoperatively by MRI. The fistula adjoined the bulbar urethra and was considered an accessory urethra. We performed resection of the fistula to resolve the frequent pus discharge and pain due to infection of the fistula. The isolated fistula did not communicate with the urethra and the proximal edge ended blindly. Pathological examination showed that the proximal end consisted of transitional epithelium and the distal end consisted of stratified squamous epithelium which meant an accessory urethra. Accessory urethra is not a rare condition, but cases like this one with an orifice that opened at the scrotal skin are extremely rare. As the treatment for the fistula, complete resection should be indicated.