Cowper’s Glands Abscess with Spreading to Adjacent Organs and Tissues with Development of Septic Shock: An Extremely Rare Case

Abstract

Background:We present here the first case of Cowper's gland abscess complicated by septic shock and breakthrough of the abscess into the paraurethral region, cavernous body, scrotum, and pararectal tissue. Case Presentation: A 63-year-old patient was admitted with complaints of temperature increase up to 39°C, pain and enlargement of the perineum and the right half of the scrotum, frequent and difficulty urination, weakness, dizziness, dry mouth, and a sharp deterioration of the general condition. Clinical-laboratory data showed the presence of septic shock with unstable haemodynamics and many concomitant diseases. From the history, it is known that the patient for more than 20 years suffered from urinary tract infection and urinary disorders. Six months earlier, the patient underwent a puncture of a bulbourethral abscess. According to the ultrasound of the scrotum, TRUS, and MRI, bulbourethral abscess with spread to the right half of the scrotum, a part of the cavernous body, and the cellular tissue of the left sciatic-rectal fossa was diagnosed. Purulent cavities were opened with two incisions and drained. A cystostomy was installed. In the intensive care unit, according to a microbiological study (Escherichia coli, Klebsiella pneumoniae, and Klebsiella pneumoniae), antibacterial, detoxification, and symptomatic therapy of concomitant diseases were carried out together with a resuscitator and therapist. The patient was discharged on the 30th day with a negative analysis of urine culture, with a cystostomy, which was removed six months after the independent restoration of urination and closure of the fistulous passage between the urethra and Cowper's glands. Conclusion: Untimely treatment of the very rare abscess of the Cowper's gland can lead to serious complications, up to the spread of a purulent process to neighbouring organs and tissues, and the development of septic shock, which will require urgent and intensive therapy with the involvement of experts from interdisciplinary fields.

Large, infected Cowper’s syringoceles: a rare cause of perineal sepsis in adult men

“…Management of this condition is challenging. The approach of defunctioning the urethra and percutaneous aspiration has been attempted elsewhere to good effect [ 14 ], but has not prevented a recurrence in other cases [ 15 , 16 ]. However, surgical management would require a large perineal incision and potentially urethral repair if involved.…”

“…However, surgical management would require a large perineal incision and potentially urethral repair if involved. This has implications of delayed wound healing, persistent infection and has been associated with urethral fistulation [ 15 , 16 ]. In both cases, the patients remained clinically stable, and there was considerable multidisciplinary discussion and consultation with the patient and next of kin.…”