Cowper's syringocele: Symptoms, classification and treatment of an unappreciated problem

Purpose: Cowper's syringocele is a rare deformity in the male urethra that is a distention of the duct of the bulbourethral (Cowper's) gland. We report on 7 cases, review the symptoms and pathophysiology, and propose a simplified classification of this uncommon lesion. Materials and Methods: We reviewed 7 cases of Cowper's syringocele diagnosed from 1997 to 1998 at our hospital. Results: Cowper's syringocele was diagnosed in 7 patients 25 to 51 years old with persistent post-void dribbling, frequency, urethral pain, hematuria or sudden urethral discharge. Diagnosis was made with urethrocystoscopy or retrograde urethrogram. Cowper's syringocele may be closed (a distended cyst-like swelling in the wall of the urethra) or open (an opening enabling urine reflux into the syringocele), In 2 patients asymptomatic open syringocele was diagnosed, In 1 patient symptomatic syringocele resolved spontaneously following an infection. In 4 patients open syringocele was treated with transurethral marsupialization because of persistent post-void dribbling. Postoperatively patients were completely symptom-free with a mean followup of 12 months (range 6 to 23), Conclusions: Cowper's syringocele may be more common than currently realized. Urologists should rule out this possibility in young male patients with lower urinary tract symptoms and persistent post-void dribbling as it can be treated easily.