Cowper’s syringocele (bulbourethral cyst)

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Abstract

Bulbourethral cyst or Cowper’s syringocele (from the Greek “syringe” – tube, “cele” – expansion) is a cystic expansion of the excretory ducts of the bulbourethral glands (Cowper’s glands). This disease is extremely rare and is more often diagnosed in the child population. The clinical manifestations of syringocele are non-specific and depend on many factors: size, localization, communication with the urethra, and the presence of an infectious component. Detection of syringocele is impossible without the use of special radiation and endoscopic diagnostic methods. Most often, this pathology is “masked” under inflammatory diseases of the genitals due to the fact that the symptoms are limited to secretions from the external opening of the urethra, changes in the general analysis of urine and dysuric manifestations. Currently in the domestic and foreign literature there are not even 20 publications devoted to this pathology.

About the authors

Vladimir V. Protoshchak

S.M. Kirov Military Medical Academy

Email: protoshakurology@mail.ru
ORCID iD: 0000-0002-4996-2927
SPIN-code: 6289-4250

Dr. Sci. (Med.), Professor, Head of Department of Urology and Urological Clinic

Russian Federation, 6 Akademika Lebedeva str., Saint Petersburg, 6194044

Alexey A. Sivakov

S.M. Kirov Military Medical Academy

Email: alexei-sivakov@mail.ru
SPIN-code: 3064-8134

Cand. Sci. (Med.), Deputy Head of the Department of Urology and Urological Clinic

Russian Federation, 6 Akademika Lebedeva str., Saint Petersburg, 6194044

Sergei M. Gozalishvili

S.M. Kirov Military Medical Academy

Author for correspondence.
Email: gozalishwili@mail.ru
SPIN-code: 8838-2460

Oncologist of Oncological Unit of Urological Clinical

Russian Federation, 6 Akademika Lebedeva str., Saint Petersburg, 6194044

Vasiliy K. Karandashov

S.M. Kirov Military Medical Academy

Email: karandashov_vk@mail.ru

Head of Oncological Unit of Urological Clinical

Russian Federation, 6 Akademika Lebedeva str., Saint Petersburg, 6194044

Alexandr E. Gorbunov

S.M. Kirov Military Medical Academy

Email: vmaaaa@yandex.ru
SPIN-code: 4863-3123

Urologist of Urological Clinic

Russian Federation, 6 Akademika Lebedeva str., Saint Petersburg, 6194044

References

  1. Cowper W. An Account of Two Glands and Their Excretory Ducts Lately Discover’d in Human Bodies. The Royal Society. 1699;364–369.
  2. Gajvoronskij IV. Normal’naja anatomija cheloveka. 7 edition. Saint Petersburg, SpecLit; 2011. 423 p. (In Russ.)
  3. Wein A, Kavoussi L, Partin A, Peters C. Campbell-Walsh Urology. 11 ed. Elsevier; 2015. 4186 p.
  4. Maizels M, Stephens FD, King LR, Firlit CF. Cowper’s syringocele: a classification of dilatations of Cowper’s gland duct based upon clinical characteristics of 8 boys. J Urol. 1983;129(1):111–114. doi: 10.1016/s0022-5347(17)51946-1
  5. Bevers RF, Abbekerk EM, Boon TA. Cowper’s syringocele: symptoms, classification and treatment of an unappreciated problem. J Urol. 2000;163(3):782–784. doi: 10.1016/s0022-5347(05)67803-2
  6. Melquist J, Sharma V, Sciullo D, et al. Current diagnosis and management of syringocele: a review. Int Braz J Urol. 2010;36(1):3–9. doi: 10.1590/s1677-55382010000100002
  7. Campobasso P, Schieven E, Fernandes EC. Cowper’s syringocele: an analysis of 15 consecutive cases. Arch Dis Child. 1996;75(1):71–73. doi: 10.1136/adc.75.1.71
  8. Blasl F, Rösch WH, Koen M, et al. Cowper’s syringocele: A rare differential diagnosis of infravesical obstruction in boys and young adults. J Pediatr Urol. 2017;13(1):52.e1–52.e5. doi: 10.1016/j.jpurol.2016.08.023
  9. Selli C, Nesi G, Pellegrini G, et al. Cowper’s gland duct cyst in an adult male. Radiological and clinical aspects. Scand J Urol Nephrol. 1997;31(3):313–315. doi: 10.3109/00365599709070358
  10. Wu F, Park E, Udayasankar U. Cowper gland syringocele. J Urol. 2013;190(2):713–714. doi: 10.1016/j.juro.2013.04.079
  11. Masson JC, Suhler A, Garbay B. Cowper’s canals and glands. Pathological manifestations and radiologic aspects. J Urol Nephrol (Paris). 1979;85(7–8):497–511.
  12. Awad MA, Alwaal A, Harris CR, et al. Transurethral Unroofing of a Symptomatic Imperforate Cowper’s Syringocele in an Adult Male. Case Rep Urol. 2016;2016:3743607. doi: 10.1155/2016/3743607
  13. Piedrahita YK, Palmer JS. Case report: Cowper’s syringocele treated with Holmium: YAG laser. J Endourol. 2006;20(9):677–678. doi: 10.1089/end.2006.20.677
  14. Santin BJ, Pewitt EB. Cowper’s duct ligation for treatment of dysuria associated with Cowper’s syringocele treated previously with transurethral unroofing. Urology. 2009;73(3):681.e11–13. doi: 10.1016/j.urology.2008.03.020
  15. Redman JF, Rountree GA. Pronounced dilatation of Cowper’s gland duct manifest as a perineal mass: a recommendation for management. J Urol. 1988;139(1):87–88. doi: 10.1016/s0022-5347(17)42301-9
  16. Cerqueira M, Xambre L, Silva V, et al. Imperforate syringocele of the Cowper’s glands laparoscopic treatment. Actas Urol Esp. 2004;28(7):535–538. doi: 10.1016/s0210-4806(04)73125-3
  17. Yamada T, Nakane K, Kanimoto Y. Successful treatment by transperineal percutaneous sclerosis with minocycline hydrochloride for imperforate Cowper’s syringocele in a young man. Int J Urol. 2009;16(9):771. doi: 10.1111/j.1442-2042.2009.02362.x.

Supplementary files

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2. Fig. 1. Page of editions describing the bulbourethral glands: a – the first description of Jean Mery from the French edition of the Journal des scavans (1684); b – title page of W. Cowper’s work “An Account of Two Glands and Their Excretory Ducts Lately Discover’d in Human Bodies” (1699)

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3. Fig. 2. Organocomplex of the small pelvis of a man according (to: W. Cowper, 1699). 1 – prostate gland, 2 – bulbourethral glands, 3 – urethra, 4 – seminal vesicles

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4. Fig. 3. Types of Cowper’s syringocele according to R. Bevers [5]: a – closed; b – open

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5. Fig. 6. Patient Sh., 19 years old: a – ascending urethrogram of the filling defect corresponding to the location of the bulbourethral cyst is determined (indicated by the arrow); b, c – magnetic resonance imaging of the small pelvis, in two projections a cystic formation is determined – a syringocele with thin septa (indicated by arrows)

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6. Fig. 7. Urethroscopic picture of patient Sh., 19 years old: a – the anterior wall of the bulbourethral cyst; b – the septum in the cyst (indicated by arrows)

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7. Fig. 8. Patient Sh., 19 years old: a – urethroscopic picture of (the arrow indicates the “window” of the emptied cyst); b – control magnetic resonance imaging of the small pelvis without signs of cystic enlargement (the arrow indicates the place of the previously located cyst)

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8. Fig. 4. Proposed algorithm for the diagnosis of Cowper’s syringocele

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9. Fig. 5. Uroflogram of patient Sh., 19 years old

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