By folloeing the main stem over a ureteruc cath. Or a guide wire and removing all the ramifications all in one block and then deal with the remaining urethral defect accordingly
Exclude the possibility of a malignancy. Once you know there is no malignancy correct the stricture which is the usual cause for a fistula. Then keep a urethral catheter indwelling for several weeks. The fistula will heal.
Exclude,TB or malignancy. THEN OPEN SURGERY IS THE ONLY OPTION WITH EXCISION OF ALL THE FISTULOUS TRACTS AND RE ANASTOMOSIS OR GRAFT ACCORDING TO THE DEFECT. THE EXCISED PART SHOULD BE SENT FOR HISTOPATHOLOGICAL EXAMINATION.