The 'watering-can' perineum: presentation and management

Area of Science:

• Urology
• Surgical Procedures

Background:

• Post-inflammatory urethral strictures can lead to complex conditions like 'watering-can' perineum.
• Accurate anatomical localization of strictures and associated pathologies is crucial for effective treatment.

Purpose of the Study:

• To determine the incidence of 'watering-can' perineum in post-inflammatory urethral strictures.
• To evaluate anatomical localization methods for these strictures.
• To assess the efficacy of direct-vision internal urethrotomy (DVIU) for treating these conditions.

Main Methods:

• 216 patients with post-inflammatory urethral strictures were evaluated between 1990 and 1996.
• Ascending urethrography and urethroscopy were used for diagnosis and anatomical assessment.
• Direct-vision internal urethrotomy (DVIU) was the primary treatment, with concurrent management of associated pathologies like calculi and diverticulae.

Main Results:

• 44 patients presented with a 'watering-can' perineum.
• Urethrography and urethroscopy successfully located strictures in all 44 patients.
• 12 patients had associated urethral calculi.
• 28 patients achieved complete fistula healing after one DVIU; 11 required two, and 5 needed more than two procedures.

Conclusions:

• Direct-vision internal urethrotomy (DVIU) is an effective treatment for urethral strictures complicated by urethrocutaneous fistulae.
• DVIU aids in detecting associated urethral pathologies.
• The procedure offers benefits of minimal hospital stay, low morbidity, and repeatability as a day-case procedure for recurrent strictures.