Watering-can perineum is a very rare complication of extensive periurethral fibrosis which can lead to multiple abscesses and fistula in the perineum. These patients are continent but when the void urine leaks out through multiple holes in the perineum.
In serious cases, the commonest cause of watering-can perineum was BXO. The traditional operation was described as Johansons two-stage urethroplasty.
In the first stage, the urethra is opened ventrally, and the skin edges are sutured to the urethra margins, the fistulae are opened. In the second stage, an approximate of 3 cm wide “U” incision is made to tubularise the skin into urethra.
During this procedure the perineal skin on both sides of the urethral plate of the narrow urethral plate is turned into urethra inside. The use of genital skin in BXO is not recommended, so the failure rate of this procedure is high in BXO.
Doctors presented a new technique of urethroplasty for watering-can perineum at 2002 AUA. In the first stage, the bulbar urethra is mobilized from the corpora cavernosa opened dorsally.
The right edge of the urethra is fixed to the corpora cavernosa, the left edge of the urethra is fixed to the right edge of the skin.
The left edge of the skin is fixed to the corpora cavernosa leaving a raw area of 1.5 cm wide on the cavernosa.
In step two, after three months, the epithelium covering the corpora cavernosa is excised and is replaced by buccal mucosa graft.
The left edge of the urethra is released from the right skin margin and the urethra is used as a ventral plate to cover the buccal mucosa graft placed dorsally.
The skin edges are sutured to close the wound. The advantage of this technique is genital skin is not utilized for this urethroplasty.