Urethral syringocele: unseen but existing

Abstract

Background: Bulbourethral syringocele is an uncommon and under-diagnosed condition most commonly seen in the paediatric population, although there is increasing recognition in adults. Due to the difficulty in diagnosis, we report our experience of urethral syringocele in a quaternary paediatric hospital, with differing presentations, diagnosis and treatment. Methods: This is a retrospective review of seven cases of children over a period of 14 years, including their presentations, diagnosis, treatment and follow-up. A review of the current literature is presented. Results: The median age of these seven cases at presentation was 11 years (6 days to 16 years). Clinical features varied with age, with obstructive uropathy in a neonate, urinary tract infection in an infant, scrotal abscess in two children and lower urinary tract obstructive symptoms in three teenagers. Diagnostic voiding cystogram diagnosed the majority of syringoceles and two were seen on magnetic resonance imaging. Five boys underwent endoscopic transurethral deroofing and two children required transperineal marsupialization. Long-term follow-up showed all had complete resolution of symptoms. Conclusion: Urethral syringocele presents from the neonatal period to late adolescence, with the presenting features reflective of age. Surgical management can be performed endoscopically or by open approach. Awareness of this condition and inclusion in the differential diagnosis, particularly in the setting of an atypical or recurrent scrotal abscess, could avoid a prolonged therapeutic course.

Cowper’s Syringocele: A Literature Review

“…In the most severe cases, it can cause antenatal bilateral hydroureteronephrosis resulting in intrauterine/perinatal death and in the neonates, it can result in vesicoureteral reflux progressing to hydronephrosis and renal failure [ 13 ]. In children, it can manifest as a scrotal mass/abscess [ 16 ]. In adults, especially if the gland is involved, can cause perineoscrotal mass/abscess and chronically discharging perineal sinus/fistula [ 15 , 17 - 18 ].…”

“…Mild to moderate duct dilatation or open syringocele can manifest as post-void incontinence, hematuria, urethral discharge, and UTI. In contrast, closed syringocele or large cysts with grossly dilated ducts can present with obstructive urinary symptoms, for instance, dysuria, weak urine stream, urinary retention, and perineal pain [15][16][17]. In the most severe cases, it can cause antenatal bilateral hydroureteronephrosis resulting in intrauterine/perinatal death and in the neonates, it can result in vesicoureteral reflux progressing to hydronephrosis and renal failure [13].…”