Syringocele of the Cowper’s gland: report of two cases in the childhood

Abstract Syringocele is an uncommon abnormality of the male urethra, that consists of a cystic dilation of the main duct of Cowper’s bulbourethral gland showing various radiographic patterns. This rare entity is frequently asymptomatic and uncommon in children and may cause dysuria, pollakiuria, stranguria, urinary infections, haematuria and obstructive voiding symptoms. There are four morphological types: simple, perforated, imperforate and ruptured. The diagnosis is usually made by voiding cystourethrography and confirmed with urethrocystoscopy. Transperineal ultrasound and MR may be also utilized for the final diagnosis. The clinical significance of Cowper’s syringocele lies in its potential to cause urethral obstruction. Careful clinical, radiological, endoscopic, and urodynamic evaluation is therefore mandatory in order to avoid unnecessary surgery. We hereby describe two patients with syringocele; the first case is a simple syringocele with only minimal dilation of the distal portion of Cowper’s gland and evidence of reflux from the urethra into the duct; the second case is a ruptured syringocele with evidence of a cystic dilation of the duct of Cowper’s bulbourethral glands with regular margins and urethral compression; both patients were treated with transurethral marsupialization and had an uneventful postoperative course and are completely symptoms-free 2 years after the initial diagnosis. Cowper’s syringocele may be more common than currently realized. Radiologists should be aware of this rare entity and rule out this possibility in young male patients with lower urinary tract symptoms and persistent post-void dribbling as it can be easily treated.