ABSTRACT
Cowper's syringoceles are uncommon, usually described in children and most commonly limited to the ducts. We describe more complex variants in an adult population affecting with varying degrees of severity, the glands themselves, and the complications they may lead to. One hundred consecutive urethrograms of patients with unreconstructed strictures were reviewed. Twenty-six patients (mean age: 41.1 years) with Cowper's syringoceles who were managed between 2009 and 2016 were subsequently evaluated. Presentation, radiological appearance, treatment (when indicated), and outcomes were assessed. Of 100 urethrograms in patients with strictures, 33.0% demonstrated filling of Cowper's ducts or glands, occurring predominantly in patients with bulbar strictures. Only 1 of 26 patients with non-bulbar strictures had a visible duct/gland. Of 26 symptomatic patients, 15 presented with poor flow. In four patients, a grossly dilated Cowper's duct obstructed the urethra. In the remaining 11 patients, a bulbar stricture caused the symptoms and the syringocele was identified incidentally. Eight patients presented with perineal pain. In six of them, fluoroscopy and magnetic resonance imaging (MRI) revealed complex multicystic lesions within the bulbourethral glands. Four patients developed perineoscrotal abscesses. In the 11 patients with strictures, the syringocele was no longer visible after urethroplasty. In three of four patients with urethral obstruction secondary to a dilated Cowper's duct, this resolved after transperineal excision (n = 2) and endoscopic deroofing (n = 1). Five of six patients with complex syringoceles involving Cowper's glands were excised surgically with symptomatic relief in all. In conclusion, Cowper's syringocele in adults is more common than previously thought and may cause lower urinary tract symptoms or be associated with serious complications which usually require surgical treatment.
ABSTRACT
Cowper's syringoceles are uncommon, usually described in children and most commonly limited to the ducts. We describe more complex variants in an adult population affecting with varying degrees of severity, the glands themselves, and the complications they may lead to. One hundred consecutive urethrograms of patients with unreconstructed strictures were reviewed. Twenty-six patients (mean age: 41.1 years) with Cowper's syringoceles who were managed between 2009 and 2016 were subsequently evaluated. Presentation, radiological appearance, treatment (when indicated), and outcomes were assessed. Of 100 urethrograms in patients with strictures, 33.0% demonstrated filling of Cowper's ducts or glands, occurring predominantly in patients with bulbar strictures. Only 1 of 26 patients with non-bulbar strictures had a visible duct/gland. Of 26 symptomatic patients, 15 presented with poor flow. In four patients, a grossly dilated Cowper's duct obstructed the urethra. In the remaining 11 patients, a bulbar stricture caused the symptoms and the syringocele was identified incidentally. Eight patients presented with perineal pain. In six of them, fluoroscopy and magnetic resonance imaging (MRI) revealed complex multicystic lesions within the bulbourethral glands. Four patients developed perineoscrotal abscesses. In the 11 patients with strictures, the syringocele was no longer visible after urethroplasty. In three of four patients with urethral obstruction secondary to a dilated Cowper's duct, this resolved after transperineal excision (n = 2) and endoscopic deroofing (n = 1). Five of six patients with complex syringoceles involving Cowper's glands were excised surgically with symptomatic relief in all. In conclusion, Cowper's syringocele in adults is more common than previously thought and may cause lower urinary tract symptoms or be associated with serious complications which usually require surgical treatment.
Subject(s)
Adult , Humans , Male , Middle Aged , Young Adult , Bulbourethral Glands/pathology , Lower Urinary Tract Symptoms/pathology , Pelvic Pain/pathology , Urethral Stricture/pathologyABSTRACT
A seringocele de Cowper é uma condição incomum que consiste na dilatação cística dos ductos das glândulas de Cowper, também conhecidas como glândulas bulbouretrais. A sintomatologia é inespecífica, tendo início durante a infância e adolescência, e em raros casos na idade adulta. O diagnóstico é realizado através da uretrocistografia retrógrada e pela uretrocistoscopia, com tratamento expectante em casos assintomáticos. Neste relato de caso é descrito um caso de seringocele com sintomas típicos e diagnóstico tardio.
The Cowper's syringocele is an uncommon condition which consists of cystic dilatation of the Cowper's glands ducts, also known as bulbourethral glands. The symptoms are unspecific. The beginning starts in childhood and adolescence and in rare cases in adulthood. The diagnosis is made by retrograde urethrocystography and urethrocystoscopy, and expectant treatment in asymptomatic cases. On this Case Report is descript a case of syringocele with typical symptoms and late diagnosis.
ABSTRACT
Cowper's syringocele is a rare but an under-diagnosed cystic dilation of the Cowper's ducts and is increasingly being recognized in the adult population. Recent literature suggests that syringoceles be classified based on the configuration of the duct's orifice to the urethra, either open or closed, as this also allows the clinical presentations of 2 syringoceles to be divided, albeit with some overlap. Usually post-void dribbling, hematuria, or urethral discharge indicate open syringocele, while obstructive symptoms are associated with closed syringoceles. As these symptoms are shared by many serious conditions, a working differential diagnosis is critical. Ultrasonography coupled with retro and ante grade urethrography usually suffices to diagnose syringocele, but supplementary procedures - such as cystourethroscopy, computed tomography scan, and magnetic resonance imaging - can prove useful. Conservative observation is first recommended, but persistent symptoms are usually treated with endoscopic marsupialization unless contraindicated. Upon reviewing the literature, this paper addresses the clinical anatomy, classification, presentation, diagnosis, and treatment of syringoceles in further detail.
Subject(s)
Adult , Child , Humans , Male , Bulbourethral Glands , Cysts/diagnosis , Genital Diseases, Male/diagnosis , Cysts/therapy , Dilatation, Pathologic/classification , Dilatation, Pathologic/diagnosis , Dilatation, Pathologic/therapy , Genital Diseases, Male/therapyABSTRACT
Cowper's syringocele is cystic dilatation of the main duct of Cowper's glands. Cowper's syringocele is usually diagnosed in male infants and children and is rarely found in adults. We present a case of Cowper's syringocele causing lower abdominal discomfort in an adult male.