|Year : 2000 | Volume
| Issue : 1 | Page : 58-60
Cowper's syringocele -an unusual presentation
Suresh Bhat, Appu Thomas, M Nazar, George C Joseph, Dharmaraj
Department of Urology, Medical College, Kottayam, India
Department of Urology, Medical College, Kottayam, Kerala - 686 008
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Cowper's syringocele is an uncommon condition occuring in children. Only occassionally it has been reported in adults. Palpable syringocele is a rarity. We report an adult who presented with palpable Cowper's syringocele.
Keywords: Cowper′s Gland; Syringocele.
|How to cite this article:|
Bhat S, Thomas A, Nazar M, Joseph GC, Dharmaraj. Cowper's syringocele -an unusual presentation. Indian J Urol 2000;17:58-60
| Case Report|| |
This 26-year-old male presented with voiding difficulty of about 3 years' duration. There was no history of urinary tract infection, trauma to the perineum or previous urinary tract surgery. Physical examination showed a small tense cystic swelling in the perineum. Lab investigations were normal. A retrograde urethrogram showed a radiolucent defect in the bulbar urethra [Figure 1]. Ultrasound examination of the upper urinary tract was normal. On endoscopic examination, the classical blue-tinted cystic swelling was seen in the floor of the bulbar urethra. This was deroofed with a Collin's knife. The patient has remained asymptomatic since then.
| Discussion|| |
The bulbourethral glands were first described orally by Mercy in 1684 but Cowper's published account of their discovery in 1699, earned him the eponym. There are 2 types of glands: diaphragmatic and accessory bulbar. The former lie dorsal to and on either side of the membranous urethra between the layers of the triangular ligament. These are tubuloalveolar glands consisting of multiple lobules, each of which is drained by a ductule. These ductules unite to form a single duct which is about 2-3 cm long and drain into the proximal bulbar urethra. These 2 main ducts empty through the minute orifices that open on either side of the midline of the ventral surface of the deep bulb. The sec-fand group of glands lie deep inside the spongy tissue and may account for some of the varied anatomical presentations of the lesion of the Cowper's glands like a swelling in the perineum.
Cowper's syringocele is cystic dilatation of the distal portion of the Cowper's gland duct. Syringocele is primarily congenital, most common among children and usually manifests as a retention cyst of the intraurethral portion of the main duct. The age of all patients with symptomatic syringocele reported by Dewan,  Brock & Kaplan  ranged from newborn to 17 years. Late appearance of syringocele has been only rarely reported.  The overall incidence of syringocele has been reported to be as low as 1.5% among cystograms done in 195 boys. Cowper's syringocele has been classified into 4 types by Maizels et al, viz., simple syringocele, perforated syringocele, imperforate syringocele, and ruptured syringocele. The one described here belongs to the imperforate type. An imperforate syringocele represents the congenitally dilated distal portion of the duct. The orifice of the duct is imperforate and does not drain into the bulbar urethra. This type appears urethrographically as a radiolucent mass that compresses the urethra. These lesions were described radiologically first by Edling in 1953. Endoscopically the cyst appears as blue-tinted translucent cystic swelling at the 6 o'clock position in the bulbar urethra without any definite ostium. Patients with Cowper's syringocele usually present with voiding symptoms, postvoiding dribbling, urinary infection, and hematuria. Occasionally it may be felt in the perineum. Voiding cystourethrogram and retrograde urethrogram are useful aids to the diagnosis. Decompression with a Collin's knife is curative. This case is reported because of it's late onset of manifestation and the unusual presentation as a mass in the perineum which is rare in Cowper's syringocele.
| References|| |
|1.||Dewan PA. A study of the relationship between Syringoceles and Cobb's collar. Eur Urol 1996; 30: 119-124. [PUBMED] |
|2.||Brock WA, Kaplan GW. Lesions of Cowper's glands in children. J Urol 1979; 122: 121-123. [PUBMED] |
|3.||Richter S, Shalave M, Nisan Korn I. Late appearance of Cowper's syringocele. J Urol 1998; 160: 128-129. |