Tuberculosis Penis with ‘Watering Can Penis’ Appearance: Report of a Rare Case with Retrograde Urethrography and Voiding Cystourethrography Findings

Abstract

SummaryBackgroundA ‘watering can penis’ secondary to penile tuberculosis is an extremely rare clinical entity. Retrograde Urethrography – Voiding Cystourethrography evaluation of the urethra and the urinary bladder plays a very important role in the diagnostics as well as further management of the urethral abnormalities. To the best of our knowledge, this is only the second case in literature where a ‘watering can penis’ was noted secondary to penile TB. This is also the first documented case of ‘watering can penis’ as a consequence of venereal transmission of TB.Case ReportA 50-year-old male presented with multiple discharging sinuses along the penis. RGU revealed multiple, contrast-filled, narrow, irregular, fistulous tracts arising from the pendulous part of the anterior urethra. This distal segment of the pendulous part of the anterior urethra also showed significant distortion and irregular, beaded narrowing. VCUG showed a markedly-contracted and small-capacity urinary bladder with a thickened, irregular and edematous wall with multiple hypertrophied trabeculae along its walls. The patient was administered anti-tubercular treatment. At the end of this treatment regimen, a repeat RGU-VCUG will be performed and decision regarding urethroplasty and further management will be planned depending upon the presence of any remaining fistulas or strictures involving the urethra.Conclusions‘Watering can penis’ as a result of penile TB is a very rare clinical entity. The differential diagnoses of a ‘watering can penis’ should be kept in mind in the evaluation of these patients. RGU and VCUG evaluation is an important conventional imaging modality used in the evaluation of urethral strictures and fistulas in case of ‘watering can penis’.

An interesting case of vesical fistula complicating urogenital tuberculosis

“…Due to rarity of such an emergency presentation, the diagnosis can often be missed during the management of bladder perforation unless the surgeon is well versed with the clinical picture of UGTB. Chronic non-healing fistulae along the urinary tract are another common presentation of tuberculosis which is seen in endemic countries and was also seen in our index patient [4,5].…”

“…The genitourinary tract is one of the regions that can be affected by extrapulmonary tuberculosis where the diagnosis can be quite difficult [1,2]. A high index of suspicion and an awareness of the atypical clinical manifestations of urogenital tuberculosis (UGTB) are important, especially in patients from regions where tuberculosis continues to be a major public health problem [3][4][5]. Herein, we report a case of post-traumatic, scarred, small capacity bladder with non-healing suprapubic fistula who had a history of bladder perforation following trivial trauma for which an emergency laparotomy with bladder repair was done.…”

Imaging of the adult male urethra, penile prostheses and artificial urinary sphincters

“…The chronic stricturing stage presents with periurethral abscesses, perineal and scrotal fistulas, and a 'watering can' perineum. RUG may demonstrate prostato-cutaneous and urethro-cutaneous fistulas, in addition to a small-volume contracted bladder ("thimble bladder"), vesico-ureteric reflux, and ureteric strictures [22] (Fig. 10).…”