A watering can (Fig. 1) metaphorically describes the fluoroscopic demonstration of contrast opacifying multiple fistulas from the urethra to the perineum, as seen on voiding or retrograde urethrography (Fig. 2) [1]. In patients with this condition, urine exits through multiple perineal openings, hence the descriptive “watering can” [2]. The urethroperineal fistulas are sequelae of traumatic or chronic inflammatory urethral strictures [2]. Classically, this sign is associated with advanced infection of the urethra and adjacent tissues, most commonly gonorrhea. Associated paraurethral abscesses are frequent [1]. Other etiologies include schistosomiasis, tuberculosis, and Crohn’s disease [1, 2].

Fig. 1
figure 1

The watering can disperses the water stream through multiple openings in the head

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Fig. 2
figure 2

A retrograde urethrogram opacifies multiple urethroperineal fistulas in a patient with a “watering can perineum”

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The radiologic appearance is specific to fistula formation rather than a particular etiology. Consequently, determination of the cause of the fistula formation requires an appropriate history and urinalysis, and possibly urethroscopy and biopsy [1].