Lesions of Cowper's ducts and glands in infants and children

Cowper's Glands Abscess with Spreading to Adjacent Organs and Tissues with Development of Septic Shock: An Extremely Rare Case

Background

We present here the first case of Cowper’s gland abscess complicated by septic shock and breakthrough of the abscess into the paraurethral region, cavernous body, scrotum, and pararectal tissue.

Case Presentation

A 63-year-old patient was admitted with complaints of temperature increase up to 39°C, pain and enlargement of the perineum and the right half of the scrotum, frequent and difficulty urination, weakness, dizziness, dry mouth, and a sharp deterioration of the general condition. Clinical-laboratory data showed the presence of septic shock with unstable haemodynamics and many concomitant diseases. From the history, it is known that the patient for more than 20 years suffered from urinary tract infection and urinary disorders. Six months earlier, the patient underwent a puncture of a bulbourethral abscess. According to the ultrasound of the scrotum, TRUS, and MRI, bulbourethral abscess with spread to the right half of the scrotum, a part of the cavernous body, and the cellular tissue of the left sciatic-rectal fossa was diagnosed. Purulent cavities were opened with two incisions and drained. A cystostomy was installed. In the intensive care unit, according to a microbiological study (Escherichia coli, Klebsiella pneumoniae, and Klebsiella pneumoniae), antibacterial, detoxification, and symptomatic therapy of concomitant diseases were carried out together with a resuscitator and therapist. The patient was discharged on the 30th day with a negative analysis of urine culture, with a cystostomy, which was removed six months after the independent restoration of urination and closure of the fistulous passage between the urethra and Cowper’s glands.

Conclusion

Untimely treatment of the very rare abscess of the Cowper’s gland can lead to serious complications, up to the spread of a purulent process to neighbouring organs and tissues, and the development of septic shock, which will require urgent and intensive therapy with the involvement of experts from interdisciplinary fields.

Uncommon causes of anterior urethral diverticula in children: Two cases and review of literature

Anterior urethral diverticula are rare in children. Anterior urethral valves and associated diverticulum is the commonly discussed pathological entity in children. There is a lack of awareness among clinicians regarding less common presentations of anterior urethral diverticula in children; which can have a diverse involvement of the urinary tract. This report describes two uncommon presentations of anterior urethral diverticula in children, their diagnoses and management. A systematic differential diagnosis and review of anterior urethral diverticula in children is also presented.

Syringocoele of the bulbourethral duct with additional lower genito-urinary anomalies

The ultrasonographic (US) appearance of a syringocoele of the bulbourethral (Cowper) duct, with correlative urethrocystoscopic images, is demonstrated. An infant boy, 5 weeks of age, who presented with E. coli infection of the urinary tract also had bilateral hydroureteronephrosis, small bilateral simple ureterocoeles, and posterior urethral valve leaflets.

Hematospermia: imaging findings

Hematospermia is an anxiety provoking but otherwise generally benign and self-limited condition that is infrequently associated with significant underlying pathology, and is most often considered to be idiopathic in nature. Management with routine clinical evaluation, watchful waiting, and reassurance generally suffice without further diagnostic workup or treatment. Noninvasive imaging may play an important role in the diagnostic workup of men with hematospermia, particularly in those who are >40 years old, have other associated symptoms or signs of disease, or have persistence of hematospermia. Many entities may be encountered in association with hematospermia at imaging, and specific therapeutic interventions may be used if certain treatable underlying pathologies are coincidentally detected. In this comprehensive review, we discuss the potential etiologies, diagnostic workup, imaging techniques, relevant male pelvic anatomy, imaging appearance of specific associated pathologies, and treatment for hematospermia.

A neglected gland: a review of Cowper's gland

Cowper's glands are pea sized glands present inferior to the prostate gland in the male reproductive system. They produce thick clear mucus prior to ejaculation that drains into the spongy urethra. Though it is well established that the function of the Cowper's gland secretions is to neutralize traces of acidic urine in the urethra, knowledge regarding the various lesions and associated complications of this gland is scarce. This review provides a comprehensive report on the development, function and various lesions associated with Cowper's gland.

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

OBJECTIVE

To review a series of children with anterior urethral valves and diverticula, to elucidate the pathophysiology and optimal management of this entity.

PATIENTS AND METHODS

Nine cases (all boys; 1963 to 2003) were reviewed retrospectively.

RESULTS

Seven of nine boys had bulbar diverticula. Continuity between Cowper's duct and the diverticulum was noted endoscopically in two and confirmed radiographically in one. Initially, open surgery was curative but more recently endoscopic management has been the procedure of choice.

CONCLUSION

This series indicates that the distal lip of a ruptured syringocele may function as a flap-valve, leading to anterior urethral obstruction. Advances in imaging and endoscopic instruments have altered the mode of presentation and management of this entity.

Congenital urethral cysts in boys with vesicoureteric reflux

Four cases of congenital urethral cysts are reported. Diagnosis was made by endoscopy. The coincidence of urethral cysts and vesicoureteric refluxes seemed incidental in three cases. Fetal infravesical obstruction was provable in the fourth infant.

CONCLUSION

Urethral cysts should be considered in boys with vesicoureteric reflux. For the vast majority of cases it seems improbable that urethral cysts play a role in the pathogenesis of congenital vesicoureteric reflux.

Cowper's syringocele causing voiding disturbance in an adult

BACKGROUND

A 21-year-old man presented with a sudden onset of miction pain and post-void dribbling. The diagnosis was Cowper's syringocele due to the findings of retrograde urethrography and urethroscopy.

METHODS/RESULTS

The patient underwent transurethral unroofing of the syringocele. The present case is of interest because Cowper's syringocele is usually diagnosed in male infants and children and is rarely found in adults.

CONCLUSION

This lesion should be included in the differential diagnosis of voiding disturbances in adults.

[Urination disorders revealing posterior urethral valve: radiological aspects]

Posterior urethral valves represent the most common form of congenital urethral obstruction; they are due to the presence of membranous recesses within the posterior urethra. Their consequences on the lower and upper urinary tract depend on the importance of the obstacle. Moderate forms have a late clinical onset in children who present with voiding disorders and a normal upper urinary tract; in such cases, the diagnosis is difficult since typical features are absent on the urethrocystogram. Radiological signs of urethral valves should be differentiated from congenital urethral strictures which are not obstructive and from bladder dysfunctions which modify both the bladder and the urethra during micturition.

Cowper's syringocele: an analysis of 15 consecutive cases

Cystic dilatation of Cowper's gland ducts (Cowper's syringocele) is uncommon in children and is frequently asymptomatic, but it may cause urinary infection, haematuria, dysuria, and obstructive voiding symptoms. Fifteen consecutive children with syringocele aged 15 days to 15 years old are reported here. Only four patients with obstructive syringocele were successfully treated surgically; all the others were successfully treated conservatively. The true clinical significance of Cowper's syringocele lies in its potential to cause urethral obstruction. Careful clinical, radiological, endoscopic, and urodynamic evaluation is necessary in order to avoid unnecessary surgery.

Cystic dilatation of Cowper's gland duct--an overlooked cause of urethral symptoms?

Dilatation of Cowper's gland duct was diagnosed in four men with symptoms including post-voiding dribbling, frequency of micturition, dysuria and hematuria. Cystourethrography gave the correct diagnosis in all cases. Treatment consisted of transurethral incision of the cystic excretory duct, providing marsupialization into the urethra. Investigation of longstanding or recurrent episodes of urethral symptoms in men should include cystourethrography with this lesion in mind. It seems to be less rare than was previously assumed.

Pronounced dilatation of Cowper's gland duct manifest as a perineal mass: a recommendation for management

It is generally accepted that large dilatations of Cowper's gland duct presenting as a perineal mass should be managed by perineal excision. Experience with such a case suggests that if the lesion also is visualized endoscopically, transurethral unroofing should be the initial choice of management.

Cowper's syringocele causing incontinence in an adult

We report on a man with post-void incontinence owing to a dilated Cowper's duct (syringocele), which was cured by endoscopic marsupialization. The clinical, radiographical and pathophysiological features of Cowper's lesions are reviewed briefly.

Cowper's gland calcification: a new radiographic finding

Cowper's gland calcification is reported in 3 elderly patients. The anatomy, pathology, and radiology of Cowper's glands are reviewed. Postulated etiologies of Cowper's gland calcification include ductal obstruction with stasis of secretions, infection with urea-splitting organisms, and sequelae of diabetes mellitus.

Cowper's syringocele: a classification of dilatations of Cowper's gland duct based upon clinical characteristics of 8 boys

Lesions of Cowper's gland duct assume various appearances. A system to classify each of these appearances is offered to diagnose these lesions more precisely. The urethrographic and endoscopic characteristics of dilated Cowper's gland ducts noted in 8 boys are grouped as a simple classification. The dilated Cowper's duct is referred to as a syringocele (Greek syringo--tube plus cele--swelling). There are 4 groups of Cowper's syringoceles: 1) simple syringocele--a minimally dilated duct, 2) perforate syringocele--a bulbous duct that drains 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 fragile membrane that remains in the urethra after a dilated duct ruptures. Marsupialization of the syringoceles cured urine infection and hematuria but voiding symptoms may persist.

Lesions of Cowper's glands in children

Lesions of Cowper's glands in children are relatively uncommon. They may be totally asymptomatic or may cause mild irritative or obstructive voiding symptoms. We describe 4 cases to illustrate the varied manifestations of these lesions in children. A plan of treatment is suggested, which is based on the different anatomical presentations encountered.