Cowper’s Glands Cysts – A Cause of Transient Intra-Uterine Bladder Outflow Obstruction?

Abstract

We describe a case of transient intra-uterine bladder outflow obstruction secondary to a cyst of Cowper’s glands.

Anterior urethral valves and diverticula in children: a result of ruptured Cowper's duct cyst?

“…The incidence of cystic abnormalities of Cowper's duct ranges from 1.5% in a VCUG series [13] to 2.3% in an autopsy study [14]. These paired tubulo-alveolar glands lie dorsal to and on either side of the membranous urethra.…”

“…They elongate and acquire lumens, followed by branching of terminal ductules and finally differentiating into mucus-secreting acini that begin to function by 4 months gestation. These accessory sexual organs secrete a clear mucous substance during ejaculation that acts as a vehicle for spermatozoa and as a lubricant [5,14,15]. A recent description of Cowper's gland hyperplasia and cystic dilation of the gland ducts in TGF-b 2 heterozygous mutant mice implies a disturbance of stromal-epithelial interactions that supports a molecular mechanism for this disorder [16].…”

“…Interestingly the presentation of this entity has evolved from signs of lower urinary tract obstruction to those of prenatal hydronephrosis [14], a common trend for many diseases managed by the paediatric urologist since the advent of prenatal ultrasonography. The early diagnosis and management of AUVD appears advantageous in that children who present neonatally tend to have more severe urinary obstruction, as indicated by greater degrees of hydronephrosis, renal dysfunction, and at worst, the presence of urinary ascites at birth [3,[20][21][22][23].…”

A Study of the Relationship between Syringoceles and Cobb's Collar

“…The neonatal autopsy case had bilateral, thin-walled intralumenal cysts, without any evidence of bulbar ure thral narrowing and no signs of urinary tract obstruction, although a cystogram via a suprapubic stab identified grade III vesicoureteric reflux. present a cystogram with the appearance of a Cobb's col lar in 1 of their 5 cases, Yaffe and Zissin [9] found a stric ture of the bulbar urethra in 6 of 11 cases and the cysto gram of the patient reported by Dhillon et al [10] had a bulbar urethral narrowing. The presence of both the exter nal sphincter and Cobb's collar may be explained by pre vious anatomical studies of the proximal urethra.…”

Clinical course of prenatally detected primary vesicoureteral reflux

“…Mackie and Stephens [27] proposed the "ureteric bud theory," in which VUR and associated renal dysplasia may represent separate expressions of a malformed urinary tract. Transient obstruction of the male urethra during embryological development is an attractive hypothesis to explain the predominance of boys with severe reflux and renal dysplasia [28,29,30]. Urodynamic findings of detrusor hypercontractility and increased bladder wall thickness in infants with gross reflux partially support this hypothesis [3,31].…”