What urethrogram sees and a surgeon does not

INTRODUCTION

Urethrorrhagia is an infrequent sign in childhood. It should be distinguished from hematuria, since they have a different etiology.

CLINICAL CASE

11-year-old male patient with significant urethrorrhagia. Urinary sediment analysis: red blood cells++. Pelvic ultrasonography: fusiform anechoic image in the corpus spongiosum of the penile root. Retrograde urethrogram: normal anterior urethra, extraluminal contrast passage in the ventral aspect of the bulbar urethra. Cystoscopy: no pathological findings in the urethra or the bladder. Control retrograde urethrogram: cystic dilatation of Cowper's gland duct; Maizels' type 3 perforated syringocele.

DISCUSSION

Cowper's syringocele is a rare pathology. It can occur at any stage of childhood in the form of urinary infection, obstructive voiding symptoms, or urethrorrhagia. Urethrogram is key for diagnostic purposes, since most Cowper's syringoceles are detected following urethrogram or cystoscopy. Cases with functional repercussions for the urinary system require surgical treatment. Otherwise, a wait-and-see approach is feasible.

Persistent Dysuria in a Young Male

A Cowper's Duct syringocele is a rare diagnosis and currently there exists no clinical guidelines for evaluation and management. This clinical challenge illustrates the case presentation, evaluation, diagnosis, and treatment options for of a newly diagnosed Cowper's Duct syringocele.

Cowper's syringocele: A rare differential diagnosis of infravesical obstruction in boys and young adults

OBJECTIVE AND INTRODUCTION

Cowper's syringocele is a cystic dilation of the bulbourethral gland duct, initially defined by Maizels et al. in 1983. Although obstructive and non-obstructive types of this rare anomaly are described, clinical symptoms are highly unspecific. Therefore, we report 12 cases of children and young adults diagnosed with Cowper's syringocele to further clarify clinical course, comorbidity and treatment strategies.

STUDY DESIGN

We retrospectively collected clinical data of 12 children and young adults from birth to 18.5 years (median 7.2 years) who had been treated in four different institutes during a period of 16 years. The primary specific diagnostic work-up consisted of ultrasound, cystourethrography, and cystoscopy.

RESULTS

3Older patients with a median age of 11.8 years clinically presented with obstructive voiding pattern or gross hematuria; infants with a median age of 0.6 years presented with febrile urinary tract infections (UTIs). After cystoscopic confirmation in all patients, endoscopic treatment was possible in nine; open surgical resection was necessary in three patients. Because of intrauterine megacystis and chronic renal failure, one boy underwent suprapubic diversion with a cystostomy soon after birth. Owing to urological comorbidity or later complications, additional procedures were necessary, for example, resection of minor urethral valves, prophylactic circumcision for UTI, endoscopic or open antireflux procedures, and occasionally complex bladder reconstructions in the long term.

DISCUSSION

According to our data, the initial clinical symptoms of Cowper's syringocele were related to presenting age rather than the previously described type of syringocele according to Maizels et al. Infants presented with febrile UTIs; however, older boys and young adults had mainly voiding problems or nocturnal enuresis. Therefore, the clinical significance of the described syringocele types must be questioned. Eighty-three percent of our patients showed additional urological pathology such as vesicoureterorenal reflux, ureteropelvic junction obstruction, megaureter, or minor urethral valves. Thus, Cowper's syringocele hardly seems to be an isolated pathology.

CONCLUSION

Although rare, Cowper's syringoceles should be considered in differential diagnosis of infravesical obstruction in boys and young adults. Diagnostics are usually justified by presenting symptoms such as UTI or urinary flow impairment, which seem to be age dependent. Despite modern diagnostic tools, diagnosis is usually made by cystourethrography and sometimes accidentally by cystoscopy. Considerable urological comorbidities and consecutive bladder dysfunction need long-term follow-up.

[Cowper's syringocele as cause of low urinary tract symptoms in a young man]

Cowper's syringocele (CS) is a very rare deformity of male urethra causing obstructive voiding symptoms. This case presents a 39-year-old man suffering from classical low urinary tract symptoms for five years, though without nocturia. The work-up showed normal prostate-specific antigen level, benign conditions by digital rectal examination, and normal-sized prostate on ultrasound. An urodynamic study showed outlet resistance and a supplementary ultrasound of prostate indicated a cyst structure around it. The magnetic resonance imaging confirmed a CS. Marsupialisation is the treatment of choice and was implemented.

[Benign mimickers of the prostate cancer. Diagnostic challenges]

The diagnosis of prostate cancer (PCa), especially limited adenocarcinoma on needle biopsy, is often challenging. Before making diagnosis of PCa, it is prudent for the pathologist to consider different benign patterns that may lead to a false positive interpretation. Histoanatomic structures such as seminal vesicles, Cowper's glands and paraganglia along with hyperplasia, atrophy with its different patterns and adenosis may generate difficulties in differential diagnosis. Furthermore, inflammatory processes and post-treatment changes may cause problems. The above entities can in some instances simulate low-grade and less commonly high grade PCa. Knowledge of these patterns and application of appropriate immunohistochemistry will lead the pathologist to a correct diagnosis.

[Non-neoplastic alterations of the prostate. Why should pathologists know them?]

Non-neoplastic changes in the prostatic gland include inflammatory, atrophic, hyperplastic and metaplastic reaction patterns of the glandular epithelium and the fibromuscular stroma. Furthermore, histoanatomical structures from outside the prostatic gland are sometimes included in biopsy material. Knowledge of the morphological appearance of benign, reactive lesions is important in order to differentiate them from malignancies. To this aim knowing the precise location of tissue sampling as well as ancillary immunohistochemical investigations are often useful or necessary.

Histomorphological and immunohistochemical findings in testes, bulbourethral glands and brain of immunologically castrated male piglets

The aim of this study was the histological and immunohistochemical evaluation and comparison of testicular, bulbourethral and brain tissue in immunized and intact control boars. Fourteen male piglets, aged between 10 and 16 weeks, were vaccinated twice subcutaneously 4 to 5 weeks apart with Improvac, an anti-GnRH vaccine. The pigs were sacrificed 1 to 16 weeks following the second injection. Testicular weight was recorded and various tissue samples were collected and fixed in formalin and Bouin's fixative for histological examination. In addition, 2 boars were immunized five times and slaughtered 60 weeks after the last injection. Histological and immunohistological studies performed on testes and epididymes showed clear signs of atrophy in the immunized animals and a significant reduction in paired testes weight was seen in treated boars. Microscopically, the mean diameter of the seminiferous tubules was markedly reduced. Spermatogonia as well as few spermatocytes were visible between the Sertoli cells and Leydig cells were atrophic. None or only few spermatozoa were detected in the epididymis. The bulbourethral glands of immunocastrated pigs were smaller than in control pigs and showed histological evidence of atrophy. Immunohistological detection of LH and FSH in the pituitary gland of treated and control boars showed no quantifiable difference in the amount of these two gonadotropins and no lesions were visible in the hypothalamus and the pituitary gland. From our findings it can be concluded that the anti-GnRH vaccine Improvac induces severe atrophy of testes and bulbourethral glands in immunized pigs. This effect appears to be reversible, depending on the immune response of each animal and the time elapsed after the last booster injection.

Reference Histology of Veal Calf Genital and Endocrine Tissues ? An Update for Screening on Hormonal Growth Promoters

An animal experiment has been performed with 42 veal calves, 21 males and 21 females, which were fed and housed according to European regulations for veal calves. The animals were kept in six groups of seven animals and fed milk replacer supplemented with three different levels of lactulose (0%, 1% and 3%) and some roughage. At the start of the experiment the animals were 1-3 weeks of age and they were slaughtered at 26 weeks. From male animals prostate, bulbo-urethal gland and testes were sampled, from female animals Bartholin's gland, uterus, cervix and ovaries were sampled. From all animals thyroid, thymus, adrenals, liver and kidneys were sampled. Histological investigation of the prostates and bulbo-urethral glands showed normal histology. This means that dilated tubules, strong secretion, increased mucinous glandular tissue and severe hyperplasia and squamous metaplasia, as is regularly observed in practice in the Netherlands, were not present in these animals. None of these prostates would be judged as positive in the screening for hormones as is performed by the Dutch Food and Consumer Product Safety Authority (VWA). The female calves also showed normal histology of Bartholin's gland except for three animals that appeared to be in oestrus and showed some metaplasie of the ducts but with a normal gland to duct ratio. These animals would be judged as suspect. The liver and kidney showed minor alterations due to slight infections during the experimental period. This experiment showed that it is possible to raise veal calves according to the practice without getting positive histology in the prostate or Bartholin's gland.

Cowper’s syringocele in an adult

Cowper's syringocele is cystic dilatation of the excretory bulbourethral gland duct. It is an uncommon condition and is usually reported in children. There are only ten previous case reports of late presentation in adulthood to the best of our knowledge. We present the imaging findings of such a case manifesting at 30 years of age.

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.

Cowper's syringocele causing painful haematuria in an adult

A Cowper's syringocele in an adult is rare. Ten cases are reported in the world literature. The authors report a case of painful haematuria due to the presence of a Cowper's syringocele in an adult. The classification of lesions of the Cowper's gland is discussed together with common symptoms and differential diagnosis.

Siringocele imperforado de las glándulas de cowper. tratamiento por vía laparoscópica

OBJECTIVES

The authors present a clinical report of an imperforate syringocele diagnosed on a male patient and treated by laparoscopic surgery.

MATERIAL AND METHODS

A forty-four year old patient attends the emergency room with acute urinary retention. With a former history of mild obstructive voiding symptoms, he presented, at rectal examination, a bump on the left rectal wall. This patient also underwent urethrocistoscopy, sonography and retrograde urethrography. To establish the diagnose, Computerized Tomography (CT) scan and MRI were used.

RESULTS

The syringocele marsupialization by laparoscopic surgery, allowed the resolution of the clinical problem, with a good outcome. The patient was discharged 48 hours after surgery, with no need of a vesical catheter. A six month follow-up showed no recurrence.

CONCLUSIONS

The syringocele is a rare deformity which usually is asymptomatic. Of acquired or congenital etiology, it can be classified in four different morphological types: simple, perforate, imperforate and ruptured. The most frequent treatment is the marsupialization of the syringocele by endoscopic surgery, leaving a broad opening of the cavity to the urethra. Some authors recommend an open surgery excision, specially in the presence of an abscess. The laparoscopic approach becomes a minimally invasive alternative with good therapeutically outcome. In the incidentally discovered asymptomatic patients, an expectant approach is the correct approach.

Transforming growth factor-beta 2 heterozygous mutant mice exhibit Cowper's gland hyperplasia and cystic dilations of the gland ducts (Cowper's syringoceles)

Analyses of mutant mice with a deletion for the transforming growth factor beta 2 (Tgfbeta2) gene revealed cysts in the perineal/scrotal region of male mice. We present evidence from in situ, light and electron microscopy that the cysts observed in Tgfbeta2+/- heterozygous mice males derive from Cowper's gland tissue. The Cowper's glands of Tgfbeta2+/- heterozygous mutant mice display all steps of glandular hyperplasia and cystic dilation. TGF-beta isoforms and TGF-beta receptor (TbetaR-II) were localized immunocytochemically in sections of Cowper's glands. TGF-beta2 and TGF-beta3 were located predominantly in myoepithelial cells of the Cowper's gland whereas the TbetaRII was found in the plasma membrane of the acinar cells. TUNEL-assays revealed that apoptotic cell death is significantly reduced in Cowper's glands of TgfbetaB2+/- heterozygous mutant mice. The fact that Tgfbeta2+/- heterozygous mutant mice exhibit hyperplasia of Cowper's gland epithelium and Cowper's gland cysts suggests a disturbance of epithelial-stromal interaction most likely due to reduced TGF-beta2 level, accompanied by a significant decrease in apoptosis.

Infertility in CFW/R1 mice associated with cystic dilatation of the bulbourethral gland

A third of male inbred CFW/R1 mice in a breeding colony developed subcutaneous, bilateral, perineal masses determined to be cystic bulbourethral glands. The masses developed in mice between 4 and 15 months of age. After development of these perineal masses, diseased males were unable to produce offspring. Gross examination revealed the masses impinging on the scrotum and displacing the testes into the inguinal canal. The perineal masses were paired, membranous, translucent cysts, 6 to 10 mm3, attached to the bulbocavernosus muscle and connected to the pelvic urethra by way of a non-patent duct. The cysts contained a clear to tan, minimally cellular, viscous fluid with high mucus content, as documented by examination of Wright Giemsa-stained cytologic preparations. Histologic examination of hematoxylin and eosin-stained sections revealed cystic tubuloalveolar glands surrounded by striated muscle and lined by a single layer of pyramidal cuboidal to columnar epithelial cells with pale, basophilic, lacy cytoplasm and round, basal, condensed nuclei. These gross and histopathologic findings were consistent with cystic dilatation of the bulbourethral gland.

Perineal swellings in two strains of mice

Seven adult male mice of two different strains and from two different animal housing facilities were submitted for necropsy to evaluate unilateral or bilateral swellings in the ventral perineal area. On dissection, the swellings were oval to spherical cystic structures located near the base of the penis. Striated muscle and a delicate stroma encapsulated all cystic structures. Cysts were firm, tan, and filled with clear, yellow fluid, or were softer and filled with white, amorphous, marbled material and a smaller amount of clear, yellow fluid. Evaluation of the cysts led us to a diagnosis of cystic bulbourethral (or Cowper s) glands. Possible causes and the incidence of this condition in other species are discussed.

Cowper's syringocele: diagnosis based on MRI findings

An 8-year-old boy presenting with intermittent haematuria and dysuria was investigated with voiding cystourethrography (VCUG), urethroscopy and perineal MRI. VCUG and urethroscopy did not provide a definitive diagnosis, while MRI clearly demonstrated a homogeneous, oval cystic lesion extending from the bulbourethral glands and slightly impressing the bulbous urethra. The patient was found to have an imperforate Cowper's syringocele. Treatment consisted of marsupialisation and the patient became symptom free. To the authors' knowledge, this is the first description of the MRI characteristics of an imperforate Cowper's syringocele in a paediatric patient.

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.

Pour on application of growth promoters in veal calves: analytical and histological results

To investigate the possibilities for screening and confirmation methods when the 'pour on' method of application is used for administration of growth promoters, an animal experiment was performed using a cocktail of a combination of growth promoters derived from (illegal) practice. Two cocktails were used, cocktail A consisting of stanozolol and estradiol benzoate and cocktail B consisting of stanozolol, estradiol benzoate and beclomethasone dipropionate. The intended dose per animal was 110 mg stanozolol, 25 mg estradiol and 10 mg beclomethasone. The experiment was performed on 20 male veal calves, 16 treated and 4 vehicle treated controls and 3 female veal calves, 2 treated and 1 vehicle treated control. Half of the animals were shaven prior to the application of the drugs. The cocktails were administered using two types of vehicles: vehicle A; Miglyol 840 with butylated hydroxytoluene and vehicle B; di(ethyleneglycol) monobutylether. During a 28 day treatment period, one group of animals was treated once a week, another group of animals was treated once every two weeks and slaughtered. Preliminary results showed that pour on application of anabolic steroids markedly increased growth performance of veal calves, the animals treated with cocktail A performed better than the animals treated with cocktail B. Macroscopically, the thymus was reduced in weight and size in the B animals. The bulbo-urethral glands were enlarged in all treated animals. Histologically all treated animals showed squamous metaplasia in the prostate, bulbo-urethral gland and Bartholins glands. Moreover, a changed secretion pattern was observed in both the prostate and the bulbo-urethral gland. Severe cortical atrophy was observed in the thymus and to a lesser extent the adrenals of the beclomethasone treated animals. The recently discovered 16 beta-hydroxy-metabolite of stanozolol was detected in urine, in relatively high concentrations. This is the first report of the excretion of this metabolite in urine after pour on administration showing the prospect for detection of dermal treatment. Estradiol levels were remarkably elevated (up to 200 micrograms l-1) exceeding the endogenous levels (< 1 microgram l-1).

Later onset of apoptosis in the bulbourethral glands after castration compared to that in the seminal vesicles

Androgens affect many different target organs within the male reproductive tract to stimulate their development and secretory cytodifferentiation, and to maintain structure and function in adulthood. Castration causes regression of these organs via apoptosis. However, not all organs of the reproductive tract are equally sensitive to androgen withdrawal. The effects of castration on the mouse seminal vesicles (SVs) and bulbourethral glands (BUGs) were compared in terms of protein and DNA contents, epithelial apoptosis, and proliferative response of epithelial cells to androgen. Castration induced similar, marked decreases in protein contents in the SV and BUG by 2 days after castration which reached a minimum at 16 days post castration. Both organs underwent a decrease in DNA content, but the kinetics of this decline differed. In the SV, DNA content was significantly decreased by 4 days whereas in the BUG this did not occur until 16 days post castration. By day 16 both organs had regressed to roughly the same degree. The apoptotic index in the epithelium reflected this difference in timing as well. Apoptotic index of the SV epithelium was highest on day 3 after castration and declined thereafter. On the other hand, the apoptotic index in the BUG didn't begin to increase until 7 days after castration and became maximal on day 12. Daily injections of testosterone propionate (TP) from day 8, 16, or 30 after castration all increased epithelial labelling index in the SVs to a similar degree. However, the TP-induced increase in the epithelial labelling index in the BUG beginning on day 8 after castration was considerably less than that in BUGs receiving TP treatment from day 16 or 30 after castration. Thus, the proliferative response of the epithelium depended upon prior apoptosis in the gland, with the timing being delayed in the BUG as compared with the SV. The present results indicate that castration induces epithelial apoptosis and reduction in glandular DNA content considerably later in the BUG than in the SV though reduction in protein content in the BUG fell simultaneously with that in the SV.

[Ruptured syringocele of the Cowper's gland. Report of a case]

Contribution of the case report of an 18-year old patient who consulted for an early picture of haematuria with symptoms of mictional syndrome with a history of several years of urinary infection. After the urological study, the presence of a ruptured syringocele in Cowper's gland was documented in the retrograde and mictional uretrography. The treatment approach was the incision, widening the communication between the urethra and the syringocele; all manifestations disappeared after the endoscopic treatment. The etiology of syringoceles and cystic dilations of Cowper's duct and gland are usually congenital, and there is a likely association with the presence of Cobb's collar. There are four morphological types: simple, perforated, imperforated and ruptured. Most cases are asymptomatic, basically affecting children and adolescents. The usual manifestations are haematuria, symptoms of urinary infections and/or various symptoms of urethral obstruction. Diagnosis is achieved through uretrography and endoscopy. Treatment, when appropriate, is endoscopic through incision or syringocele marsupialization. In some cases, perineal incision and surgical resection of the syringocele with urethral closure has been performed.

Distinguishing Cowper's glands from neoplastic and pseudoneoplastic lesions of prostate: immunohistochemical and ultrastructural studies

Mucin-producing Cowper's glands, which are situated in the urogenital diaphragm, can be sampled inadvertently by transurethral resection of the prostate and rarely by needle biopsy. Because they are small, closely packed glandular units, Cowper's glands can be misinterpreted as prostatic adenocarcinoma. A panel of immunoperoxidase and mucin stains performed on 10 Cowper's glands showed negative immunoreactivity for prostatic-specific antigen, prostatic alkaline phosphatase, S-100 protein, and carcinoembryonic antigen. Acini in nine of the 10 Cowper's glands were negative for high-molecular-weight cytokeratin K-903 (34beta E12). One case showed faint focal staining of cells around the periphery of acinar units. Smooth muscle actin consistently stained the periphery of acini in all cases. Ultrastructural examination of one Cowper's gland showed the presence of myoepithelial cells at the periphery of the acini. Contrary to previous reports, the acini were lined by a prominent secretory cell layer underlain by an attenuated myoepithelial cell layer. A negative stain for K-903. without additional immunohistochemical study on Cowper's glands taken during transurethral resection or needle biopsy, may substantiate an erroneous diagnosis of prostatic adenocarcinoma. This potential misdiagnosis of carcinoma can be averted if samples stain positive for mucin and smooth muscle actin and negative for prostate-specific antigen and prostatic alkaline phosphatase.

Cowper's gland duct cyst in an adult male. Radiological and clinical aspects

A 48-year-old man presenting with perineal pain, weak stream and dysuria was found to have a Cowper's gland duct cyst measuring 1.8 x 3.5 cm, which was investigated with retrograde and voiding urethrography, cavernosography and perineal MRI, which was the single most useful imaging technique. Treatment consisted in complete surgical excision, which allowed an anatomical reconstruction of the urethra. This condition is typical of the pediatric age group, and seldom diagnosed in adults.

Diagnosis of Cowper's glands on prostate needle biopsy

The presence of normal anatomic structures may be a source of confusion to the pathologist examining prostatic needle biopsies. The morphologic features of Cowper's (bulbourethral) glands incidentally biopsied during transrectal sampling of the prostate have not been described. We reviewed seven cases of Cowper's glands found in prostatic core biopsy specimens. Sections containing Cowper's glands were stained with hematoxylin-eosin, mucicarmine, periodic acid-Schiff's-digest (PAS-D), and antibodies directed at high-molecular-weight cytokeratin (HMWCK), prostate-specific acid phosphatase (PSAP), prostate-specific antigen (PSA), Ulex europaeus agglutinin, and muscle-specific actin. Histologically, Cowper's glands resemble mucinous minor salivary glands entrapped within fascicles of muscle. Lobules of acini composed of cells distended with mucin (mucicarmine and PAS-D positive) were admixed with ducts and ductules composed of hybrid cells with both mucinous and ductular epithelial features. The HMWCK was strongly reactive with the ductular epithelium and demonstrated an attenuated cell lining at the periphery of lobules. The mucinous cytoplasm reacted with U. europaeus, whereas the ductal elements failed to stain. PSAP stains were negative, with PSA positive in most cases. Muscle-specific actin was positive in three cases. Cowper's glands occasionally may be sampled by transrectal needle biopsy. Recognition of this anatomic structure will allow discrimination from low-grade prostatic adenocarcinoma, foamy gland carcinoma, mucinous metaplasia of prostate glands, and atypical glands of undetermined significance.

A study of the relationship between syringoceles and Cobb's collar

OBJECT

To assess the association between the congenital narrowing of the bulbar urethra and syringoceles.

MATERIALS AND METHODS

Eleven boys were investigated, 10 with a cystogram and 9 with video endoscopy. The video tapes were reviewed with the radiology and the relationship between the syringocele and the narrowing of the bulbar urethra (Cobb's collar) was particularly noted.

RESULTS

Seven of the 9 boys examined endoscopically were found to have a Cobb's collar near the proximal extent of the syringocele; the proximal extent of external sphincter appeared to be above and separate from the syringocele in all cases. Six of 10 patients had a syringocele and bulbar urethral narrowing seen at cystogram.

CONCLUSIONS

It would appear that syringoceles are often associated with a Cobb's collar, in keeping with the possible origin of both structures from the region of the urogenital membrane. The narrowing in the bulbar urethra may, however, be an incidental finding in many of the cases.

Immunohistochemical localization of prostate-specific markers within the accessory male sex glands of Cowper, Littre, and Morgagni

OBJECTIVES

The aim of the study was to explore possible production of prostate-specific markers by the embryologically and physiologically related accessory male sex glands, other than the prostate.

METHODS

The accessory male sex glands of Cowper, Littre, and Morgagni were studied systematically in 10 whole-mount autopsy and 5 surgical cystoprostatourethrectomy specimens. Immunohistochemistry was applied with the avidin-biotin-peroxidase method and commercially available monoclonal antibodies raised against prostate-specific antigen (PSA) and prostate-specific acid phosphatase (PSAP).

RESULTS

All specimens showed clear microscopic identification of these glands except for Cowper's glands, which were not found in most of the surgical cystoprostatourethrectomy specimens but were found coincidentally in one. Localization of the prostate-specific markers PSA and PSAP was demonstrated for the first time in three Cowper's glands, but they were a consistent finding in Littre's and Morgagni's glands when immunohistochemical identification was performed in a systematic fashion.

CONCLUSIONS

PSA and PSAP are mostly produced by prostatic tissue, but not exclusively. These findings may have an impact on the specificity and sensitivity of PSA serum levels after radical prostatectomy because they support the hypothesis of extraprostatic sources of PSA.

Urethral sonography in the diagnosis of penile and bulbar urethral stenosis

Ultrasound was used in 25 patients for the study of penile (21) and bulbar (4) strictures and for the follow-up of 8 of these patients on whom dural urethroplasty was carried out. There was a good correlation with urethrography. Ultrasound has the added advantages of enabling study of the periurethral tissues without testicular irradiation, and safety and economy of the exploration.

Clinical, pathological and histopathological findings in lambs implanted with a growth promoting product containing progesterone and oestradiol

Six live wether lambs and the urogenital tracts of 4 others from 4 separate farms were presented for examination. In each case the wethers had been implanted several weeks previously with a growth promoting product containing progesterone and oestradiol. The affected wethers presented with dorsal retroflexion of a markedly distended bladder which caused persistent straining, bulging of the perineal muscles and rectal prolapse. Enlargement of the bulbo-urethral glands and seminal vesicles, with an increase in the volume and viscosity of the secretion of the bulbourethral glands was evident on gross examination. Histopathological examination of the prostate and bulbourethral glands revealed cystic dilation of the glands and hyperplasia and squamous metaplasia of the glandular epithelium. Desquamated cells and eesinophilic-staining material were present in many of the dilated lumens. In the seminal vesicles, interstitial fibrosis had resulted in the obliteration of large areas of glandular tissue. The enlargement of the prostate and bulbo-urethral glands, and particularly the increased viscosity of the gland secretions, probably hindered urination, resulting in only partial evacuation of the bladder. Attempts to urinate by active contraction of the abdominal muscles may have accounted for the dorsal retroflexion of the distended bladder. The oestrogenic influence of the growth implants is thought to be responsible for these changes.

Genital pathology of feral male goats

Genitalia from 1000 feral male goats derived from western Queensland and New South Wales were examined after slaughter at an abattoir and the prevalence of abnormalities determined. Ulcerative balanoposthitis, considered due to caprine herpesvirus infection, was observed in 11 animals (1.1%); acidophilic intranuclear inclusions were found in 7 of these. Other conditions included focal hypoplasia of seminiferous tubules in 2 bucks (0.2%), segmental aplasia of the epididymis (one buck, 0.1%), bulbourethral gland cysts with contained aggregations (33 bucks, 3.3%) and haemangiosarcoma of the bulbourethral gland in one animal. The low prevalence of several conditions such as spermatic granuloma, cryptorchidism, and testicular hypoplasia, was attributed largely to the fact that the bucks examined were horned so that the recognised association between genital abnormalities and polledness did not apply.

[Syringoceles of Cowper's glands in children]

Some tubular or cystic diverticula observed in the ventral wall of the male bulbous urethra that originate from dilatation of Cowper's gland ducts have been termed "syringoceles". They can cause dysuria, hematuria and obstruction. We report 14 syringoceles and 1 true diverticulum from segmental absence of spongious urethra. We review embryology, anatomy and diagnosis in order to determine the best therapeutic approach. We performed endoscopic resection of the distal valve-like border of the diverticulum in 6 patients (42.85%) with good results. The remaining 8 patients, in whom surgery was not indicated, were followed clinically and radiologically.

[Echotomographic evaluation of the anterior urethra]

A simple method of sonographic (US) evaluation of penile and bulbous urethra is reported. Twenty-three dysuric patients were examined. They were divided into 2 groups according to their pathology. The US patterns of normal urethra were evaluated in 10 patients (first group) with no obstructive lesions. Urethral and periurethral structures were examined in 13 patients (second group) with urethral obstructive pathology. All patients underwent conventional cystourethrography. The diagnostic parameters considered were urethral gauge and thickness, echogenicity of the urethral wall, and Cowper's glands. US evaluation of obstructive lesions provided the same findings as conventional radiological techniques. Moreover, US allowed the evaluation of both thickness and echogenicity of the urethral wall, and of normal/injured Cowper's glands.

Pathological findings in the bulbourethral glands of bulls

The bulbourethral glands of 323 Bos indicus or B. indicus crossbred bulls more than 1 1/2 years old were examined in an abattoir study. Bulbourethral adenitis was diagnosed grossly and confirmed by histological examination in 4 (1.2%). Unilateral chronic interstitial inflammation was seen in 2 cases; one of these was associated with a degenerative-type seminal vesiculitis. In the others adenitis was bilateral; in one case it was associated with a concretion and foreign (plant) material in the principal duct of the left bulbourethral gland; in the other bilateral case, numerous calculi were present and microscopically, a chronic active and diffuse inflammation was observed. Chemical analysis of the calculi showed calcium oxalate and tricalcium phosphate to be the most important components. Corynebacterium spp was isolated from the lesion with multiple calculi but attempts to isolate Chlamydia spp, Mycoplasma spp and Brucella abortus from the 4 adenitis cases were unsuccessful. Congenital abnormalities such as glandular fusion (2.2%) or unilateral aplasia (0.6%) were also observed. Cysts were the most common finding (19.2%), and duct dilation was frequent (7.1%). The significance of these findings in relation to fertility is considered.

[Cowper's canals and glands. Pathological manifestations and radiologic aspects]

From 11 personal case studies, the authors conduct a general review of the problems raised by Cowper's glands. Cowper's glands, accessory sexual glands, are made up of main glands situated behind and on either side of the bulbar urethra right at the level of the urolgenital diaphragm and of accessory glands situated in the thickness of the bulbar spongy body. The main glands are drained by long canals (several centimeters in length) which empty into the bulbar urethra by paramedian orifices. The fusion of these canals into one single canal at the urethral opening, although rare, could lead to obstruction. These canals can be the site of cystic dilatation ranging from a few millimeters to as much as 6 cm in diameter. These cysts are rarely due to terminal canal obstruction as the result of chronic inflammatory urethritis. Most often they are congenital. The cysts which develop at the level of the accessory glands are usually obstructive while those which develop at the level of the main glands rather have a perineal expansion. The indicative signs of this particular pathology are not specific (pyuria, hematuria, enureis, known urethral stenosis, dysuria with pollakuria, perineal pain with post voiding urethral dripping). Voiding urethrography investigation (the best) shows: --either cystic dilatation seen as a lacuna on the ventral aspect of the urethra, --or opacification of the dilated cavities of the exretory canals which have been spontaneously broken or opened by endoscopic manoeuvres. The opacification of these cavities leads often to the erroneous interpretation of "diverticula" of "incomplete duplication of the urethra" and yet their essential characteristic is twofold: they are oriented in an anterior-posterior direction with respect to the urethra and lead back and away from it; they have a canal type of morphology for at least part of their course.

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

Lesions of Cowper's duct and gland are more common than previously reported. They may be asymptomatic or may cause micturition difficulties or urinary retention. They may be congenital or acquired (usually inflammatory). Radiographic findings are either a rounded filling defect arising from the floor of the bulbous urethra or reflux into a dilated duct which parallels the bulbomembranous urethra. Panendoscopic fulguration is a simple and effective method of treatment for symptomatic patients with retention cysts. Asymptomatic patients do not need any therapy. A dilated duct should not be confused with partial urethral duplication, a urethral diverticulum, or an ectopic ureter since such an error may lead to an unnecessary operation.

The effect of testosterone and an anti-oestrogen on hypertrophy of bulbourethral glands of wethers grazing oestrogenic pastures

Testosterone implants (70 mg), but not an oral anti-oestrogen, prevented hypertrophy of the bulbourethral glands of wethers grazing oestrogenic pastures for 18 weeks.