Complicated male urethral strictures: Presentation and management

Abstract

Among 104 patients with urethral strictures treated over a period of 3 years, sixty-five (63%) had complications such as inflammatory periurethral mass, watering-can perineum with discharging sinuses and fistulas, associated urethral calculi, periurethral abscesses and urethral diverticula. Seventy-four per cent of the strictures were of inflammatory origin and they predominated in the region of the bulbar urethra. Thirty-two patients were treated by visual internal urethrotomy, 11 had two-stage urethroplasty and 9 had perineal urethrostomy. Other methods of treatment and their results are discussed.

Watering can perineum – a forgotten complication of gonorrhoea

“…In chronic gonorrhoea, stricture formation may occur, most commonly in the bulbous urethra, and persistent urinary fistula or multiple fistulae (watering can perineum) may result 5 . In a study from Sudan, 13 patients were noted with watering can perineum, though the number secondary to gonorrhoea was not stated 6 . In Europe and North America true chronic gonorrhoea is extremely rare and most sequelae of treated infections are related to associated non‐specific urethritis 7 .…”

“…The management of watering can perineum includes treatment of the cause with diversion of urine by suprapubic cystostomy to allow the sinuses and fistulae to heal. Subsequently following evaluation of the stricture, perineal urethrostomy, two stage urethroplasty or excision of the stricture may be carried out 6 …”

“…5 In a study from Sudan, 13 patients were noted with watering can perineum, though the number secondary to gonorrhoea was not stated. 6 In Europe and North America true chronic gonorrhoea is extremely rare and most sequelae of treated infections are related to associated non-specific urethritis. 7 Our patient had watering can perineum with chronic urethritis from which gonococci were isolated by culture.…”

“…Subsequently following evaluation of the stricture, perineal urethrostomy, two stage urethroplasty or excision of the stricture may be carried out. 6 Drug resistance in gonorrhoea is commonly encountered today, thus, a resurgence of these almost forgotten complications may be seen and the medical profession must be aware of this fact so as to facilitate adequate management and follow up of the patient to prevent further morbidity. As with all sexually transmitted infections, screening and treatment of the partner is mandatory to prevent reinfection and relapse.…”