Epididymo-
cutaneous fistula was seen in a person with cervical spinal cord injury and
neuropathic bladder. This patient developed left
epididymitis; then he formed an
abscess superficial to the tail of the epididymis, which burst open to the skin discharging
pus; subsequently, this progressed to epididymo-
cutaneous fistula. A few drops of urine would leak through the
fistula. The carers kept a dressing over the
fistula to collect the small amount of urine leak and changed the dressing daily. This patient's carers squeezed any subcutaneous collection and drained the
pus through the
fistula. Serial ultrasound imaging of the scrotum was performed to guide the clinical management: (1) any subcutaneous
abscess detected by the ultrasound scan was drained promptly; (2) ultrasound scans confirmed absence of any pathology in the testis; (3) the course of the disease was monitored as chronic
epididymitis with echogenic debris in epididymal tail progressed to development of epididymo-
cutaneous fistula and later to a chronic
fistula with a matured tract. The serial scans revealed thickened tail of the left epididymis with heterogenous echo texture with no
abscess formation, which encouraged the continuation of
conservative management over a 5-year period while maintaining good quality of life. At the last follow-up in June 2022, leakage of urine from the epididymo-
cutaneous fistula was observed very infrequently (once a month).