A fistula is an abnormal connection between two organs or between one organ and the skin. A urethral fistula after phalloplasty is usually a connection between the urethral and skin.
Fistulas are caused by surgical technique at the time of the phalloplasty, infection, or often by a downstream urethral stricture that causes increased urethral pressure and an opening of the urethra.
Fixing the underlying cause such as a stricture is very important to permanently correcting the stricture. If the underlying problem is not fixed, the fistula will reoccur. In addition, the fistulous tract has to be excised in its entirety.
A suprapubic tube is a catheter that goes directly in to the bladder from the lower part of the abdomen. This tube is placed to divert the urine away from the fistula to give time to allow the body to start to heal. Sometimes, a fistula is accompanied by infection and inflammation of tissues and urine leaking into this area makes this condition worse. By moving urine away from the fistula and into the suprapubic tube, inflammation and infection can improve and buy time before more definitive surgical repair of the fistula is undertaken.
It depends on how complex the surgery is and what areas are involved. If the fistula is a simple fistula without infection that is not caused by a downstream stricture than the surgery may be an outpatient surgery without significant pain. More complex fistulous with infections may need a longer hospital stay with more complicated surgical procedures.