title: The 'watering-can' perineum: presentation and management.
abstract: OBJECTIVE
  To assess the frequency of 'watering-can' perineum among patients with post-inflammatory urethral strictures, to evaluate methods of anatomical location and to assess the efficacy of direct-vision internal urethrotomy (DVIU) in this condition.
  
  
  METHODS
  From 1990 to 1996, 216 patients with post-inflammatory urethral strictures were evaluated; all underwent ascending urethrography and urethroscopy and 44 were found to have a 'watering-can' perineum. These patients were evaluated further for the presence of associated urethral pathology. e.g. calculi and diverticulae. DVIU was performed as the primary method of treatment and any associated urethral pathology treated at the same time. The follow-up ranged from 3 to 36 months (mean 20).
  
  
  RESULTS
  Ascending urethrography and urethroscopy located the site of the stricture in all 44 patients: 12 had associated urethral calculi. In 28 patients, the fistulae healed completely after a single DVIU, a further 11 required two urethrotomies, while the remaining five required more than two urethrotomies to treat the stricture.
  
  
  CONCLUSIONS
  DVIU can be used to treat strictures complicated by urethrocutaneous fistulae, and for detecting associated urethral pathology. It has the advantage of requiring a minimal hospital stay, provoking minimal morbidity and the procedure can be repeated as a day-case if the stricture recurs.
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Khartoum, Sudan.
authors.forename: A R
authors.initials: AR
authors.lastname: Sharfi
authors.forename: Y E
authors.initials: YE
authors.lastname: Elarabi
mesh_terms: D000328:Adult; D017577:Cutaneous Fistula / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D014525:Urethral Stricture / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D014526:Urethritis / Q000150:complications*; D014548:Urinary Fistula / Q000209:etiology