Wednesday, March 7, 2018

Cowpers duct syringocele

Ryan Schwope

Ryan Schwope

Ryan Schwope
Axial contrast-enhanced CT (top), axial T2W MRI (middle), and sag T2W with fat-saturation MRI (bottom)
demonstrate an ovoid cystic structure associated with the midline posterior aspect of the bulbous urethra
  • The Cowper glands (bulbourethral glands) are paired pea-sized accessory exocrine glands analogous to the Bartholin glands in females
    • The main glands lie within the urogenital diaphragm
    • The ducts insert into the bulbous urethra  
    • Provide lubrication of the urethra and protection of the sperm
  • Obstruction of the ducts may result in formation of retention cysts, also referred to as syringoceles
    • May be congenital or acquired 
    • Most often asymptomatic although when large, may result in urinary obstruction and hematuria
  • Categorized as either open or closed 
    • Open cysts communicate with the lumen of the urethra and may mimic a urethral diverticulum or even an ectopic ureter
      • More likely to cause symptoms of postvoid dribbling, purulent discharge and hematuria
    • Closed or imperforate cysts become dilated due to duct obstruction resulting in cyst dilatation and extrinsic mass effect on the bulbar urethra
      • More likely to result in obstructive symptoms
  • Imaging typically detects a Cowper duct cyst as a unilocular cystic lesion at the posterior or posterolateral aspect of the posterior urethra 
    • Open cysts may be opacified during urethrography 
    • Closed cysts may appear as a smooth extrinsic filling defect on the ventral wall of the bulbous urethra 
    • MRI is useful to exclude solid neoplasms and to detect complications such as hemorrhage or infection
  • Symptomatic cases are treated surgically with cyst unroofing. Transperineal ligation of the Cowper gland ducts may be performed in refractory cases


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