A 30-year-old man in Nigeria presented with a peculiar medical case: urine leaking from multiple points on his perineum for two weeks. Doctors diagnosed the condition as a “watering can” perineum, accompanied by symptoms like a weak urine stream, urethral discharge, dribbling, and burning sensations. This case is unusual because the underlying cause was not a typical nerve or muscular issue, but a severe physical obstruction.
Initial Diagnosis and Complications
The patient’s weak urine flow necessitated immediate bladder drainage before further investigation. Attempts to insert a catheter through the urethra failed due to an unknown blockage. Surgeons bypassed the obstruction by inserting a catheter directly into the bladder via abdominal incision. Urine analysis revealed a Staphylococcus aureus infection, which is rare in urinary tracts unless there is a physical impediment allowing the bacteria to thrive.
Imaging Reveals Unique Morphology
Radiological scans with contrast dye revealed an abnormally shaped bladder. The organ had inflated at its base, forming a distinct pointy tip resembling a Christmas tree or pinecone. Despite the unusual morphology, initial scans showed no issues within the bladder itself, such as tumors or stones.
This shape – known medically as a “Christmas tree” bladder – is typically caused by neurological problems preventing complete emptying, such as spinal cord injuries or nerve damage from diseases like multiple sclerosis. However, in this case, the problem was structural.
Identifying the Root Cause: Urethral Stricture
Further imaging pinpointed the issue: a severe narrowing of the urethra, known as a urethral stricture. This obstruction cut off urine flow, forcing the bladder to overinflate and take on its distinctive shape.
Urethral strictures can arise from pelvic injuries, sexually transmitted infections, tumors pressing against the urethra, or remain idiopathic (no identifiable cause). The specific cause in this patient was not determined in the case report.
Treatment and Implications
The patient received antibiotics for the staph infection and underwent surgery to reconstruct the urethra. While surgery offers relief, urethral strictures often recur. This case is notable because a stricture is an uncommon cause of a Christmas tree bladder. More frequently, the condition arises from nerve or muscle dysfunction, not a physical obstruction.
The case underscores the importance of comprehensive imaging when dealing with unusual urinary symptoms. A Christmas tree bladder is usually linked to neurological issues, but this patient demonstrates that structural problems can also be responsible.
This finding highlights the need for thorough diagnostic work-ups to avoid misattributing complex symptoms to the wrong underlying mechanism.
