Watering Can Perineum

Watering can perineum refers to urination through the perineum due to multiple urethroperineal fistulas. Urethroperineal fistulas are most commonly caused by chronic inflammatory urethral strictures due to tuberculosis, schistosomiasis, or gonorrhea.

On retrograde urethrography, there is typically an anterior urethral stricture associated with multiple prostatocutaneous and urethrocutaneous fistulas.

It may be difficult to visualize the entire urethra, since instilled contrast leaks out of the fistulas before opacifying the more proximal urethra. Fistulography, therefore, may be needed to visualize the entire urethra.

Management includes treatment of the cause of stricture (e.g., antibiotics) and diversion of urine with suprapubic cystostomy. Once the fistulae have healed attention is directed to relieving the stricture.

References

Kawashima A, Sandler CM, Wasserman NF, LeRoy AJ, King BF Jr, Goldman SM. Imaging of urethral disease: a pictorial review. Radiographics. 2004 Oct;24 Suppl 1:S195-216.