Cowper's Syringocele (Cyst of the Bulbar Urethra): A Case Report and Literature Review

Abstract

A Tayib, H Mosli, M Atwa, Cowper's Syringocele (Cyst of the Bulbar Urethra): A Case Report and Literature Review. 2003; 23(3-4): 194-195 Cowper's glands are two bulbourethral glands that lie superior to the perineal membrane and are invested in the broad base of the external urethral sphincter muscles.1 During sexual excitement these glands secrete clear mucous into the bulbous urethra. A syringocele is a deformity in the male urethra in which there is a distention of the bulbourethral Cowper's glands. In 1684, Merry described the bulbourethral gland. A complete description of the gland was published in 1699 by Cowper.1 Thesyringocele was first described by Fenwick. 2 A literature review found that Cowper's syringocele may be more common than currently realized. 3 We report a case of bulbous urethral cyst arising from the Cowper's gland in a 34-year old male patient. Case reportA 34-year old male presented to us with perineal pain and microscopic hematuria. There was no history of medical or surgical illness. Frequent urinalysis showed persistent microscopic hematuria. Intravenous pyelography and urine cytology were normal. Cystoscopic examination revealed a cystic swelling at the proximal part of the bulbar urethra close to the external urethral sphincter, which had a very tiny pin-hole aperture (Figure 1). A retrograde urethrogram showed swelling in the proximal bulbar urethra that did not empty after complete emptying of the bladder and urethra (Figure 2). We performed a transurethral endoscopic deroofing of the cyst. Cystourethroscopy and urinalysis 3 months later were normal. Our case was an imperforate synringocele. DiscussionThe dilated Cowper's gland ducts are referred to as asyringocele. Based on radiological and cystoscopicappearance, syringoceles are classified into four groups: 1)simple syringocele, a minimally dilated duct; 2) perforatedsyringocele, a bulbous duct thatdrains into the urethra via a patulous ostium and appears as a diverticulum; 3) imperforate syringocele, a bulbous duct that resembles a submucosal cyst and appears as a radiolucent mass; and 4) ruptured syringocele, the fragilemembrane that remains in the urethra after a dilated duct ruptures. 4 In a PubMed and Medline literature search, we found 20 cases of syringoceles. Twenty cases were group 2, 3, and 4 syringoceles, and 13 cases were group 1 syringoceles. Our case was an imperforate syringocele.

Practical Review of the Current Management of Fournier’s Gangrene

“…123 Although incidence is not widely reported, we found that 290 (2.6%) of 11,069 patients underwent orchiectomy. 4,11,17,20,22,23,[26][27][28][41][42][43]47,50,[53][54][55][56]60,66,70,79,91,95,98,101,103,104,109,112 Yanar et al 60 found that when orchiectomy was performed, using surgeon judgment, 100% of final histologic analysis showed normal testicular tissue with no signs of FG-supporting the principle that orchiectomy is often not necessary. There are no guidelines about the best timing to perform orchiectomy when needed.…”

“…*An estimated 61 of 108 studies quantify patients who underwent culture 4,8,11,12,17,18,20,21,[23][24][25]30,31,34,[36][37][38][41][42][43][44][45][46]49,50,52,56,57,59,60,63,69,72,76,77,80,82,[84][85][86][87][89][90][91][93][94][95][96][98][99][100][101][102]…”

Cowper’s Syringocele: A Literature Review

“…Cowper's gland develops from the urogenital tubercle, derived from the pericloacal mesoderm, for which androgens play a pivotal role [ 4 ]. They are located in the wide base of the external urethral sphincter muscles in the deep perineal pouch, posterolateral to the membranous urethra, and superior to the perineal membrane [ 5 - 6 ]. The Cowper's gland ducts open into the bulbous urethra in the superficial perineal pouch by penetrating the perineal membrane [ 7 ].…”