Cowper's Syringocele in Adolescent Male: Case Report

Abstract

Background: Cowper's syringocele is a rare condition, uncommon in the adult population. It is more common in the pediatric population. Patients could be asymptomatic or present with irritative and/or obstructive symptoms. Ultrasonography (US) of perineal region, pelvis MRI, or urethrography are the most often used diagnostic modalities. Surgical treatment is indicated in all symptomatic patients. Endoscopic approach is preferred over open surgery. Unroofing of syringocele with cold knife or holmium yttrium aluminium garnet (YAG) laser is effective treatment.Case Presentation: A 17-year-old Caucasian male presented at our emergency department with irritative symptoms. US of perineal region showed cystic formation near urethra. Pelvis MRI showed Cowper's gland syringocele. Endoscopic unroofing with holmium YAG laser was performed. Six months postoperatively the patient was asymptomatic and satisfied with the treatment.Conclusion: Cowper's syringocele is a rare condition. Urologist should consider this condition in pediatric and adolescent patients with irritative and/or obstructive symptoms. Pelvis MRI and perineum US are the main diagnostic tools. Surgical treatment is effective. Endoscopic approach is preferred. Open surgery is indicated in complicated cases and in cases when endoscopic treatment fails.

Successful treatment of a rare Cowper’s bulbourethral gland syringocele in an adult with endoscopic laser deroofing using a rigid ureteroscope

“…Electric resection with loop cautery alone 10 or in combination with the use of a knife has also been described as successful. Laser deroofing has been described in a recent similar case in an adolescent 11 treated with the use of a cystoscope and an Albarran bridge. This poses a lower theoretical risk of stricture formation over loop excision due to a more superficial depth of penetration of laser, as well as a more precise target for excision, lending itself as a favourable choice.…”

Cowper’s Syringocele: A Literature Review

“…Detailed history-taking, which includes the urological symptoms, can help with the diagnosis [ 21 ]. Transperineal or transrectal ultrasound can be used to detect the Cowper's glands' cystic lesions with the benefits of being affordable, non-invasive, and radiation-free.…”

“…Cystourethroscope, an invasive procedure, shows an imperforate syringocele as an extrinsic mass arising from the bulbar urethral floor, while a perforated syringocele would manifest as a pouch connecting to the bulbous urethra [ 24 ]. Further investigations, such as urodynamic studies and CT or MRI scans of the perineum, can be carried out if more information is required [ 21 ]. MRI also helps diagnose Cowper's syringocele by exhibiting a homogeneous cystic lesion with the advantage of being radiation-free non-invasive imaging with a broader field of vision.…”

“…With a maximum follow-up period of almost two years in the Bevers et al case series, all four patients experienced complete resolution of the symptoms who underwent the deroofing procedure [ 14 , 17 ]. The successful implication of the Holmium: Yttrium Aluminum Garnet (YAG) laser for syringocele intervention which Piedrahita and Palmer initially proposed, is now more widely practiced, and recent case reports depicted that there is no need for urethral catheterization after this treatment [ 9 , 21 , 23 , 26 ]. Open methods, for instance, ligation of the Cowper's duct by transperineal approach, provide an alternative but are typically used after a failed unroofing attempt [ 27 ].…”

Incidental findings on prostate MRI: a close look at the field of view in this anatomical region

“…These glands play a role in sperm motility and urethral lubrication during ejaculation. Patients with Cowper's duct cysts complain of urinary retention, postvoid dribbling, or hematuria upon hospital admission (10,11). Urethral diverticula and duplication may be thought in the differential diagnosis (12).…”