A multicentre analysis of Cowper's gland syringoceles

INTRODUCTION & OBJECTIVES: Cowper's syringocele is a cystic dilatation of Cowper's gland ducts. It's an uncommon condition thought to be more present in the pediatric population but is increasingly being recognized in young adult men. Although the exact etiology is unclear, 2 classifications exist: obstructive (closed) and non-obstructive (open) syringoceles. In this analysis of 19 patients with a syringocele a treatment overview is presented in which 9 patients were managed conservatively and 10 underwent surgical intervention. MATERIAL & METHODS: A multicentre retrospective study was performed examining presentation, diagnosis, treatment and surgical outcome of 19 patients with a symptomatic syringocele. RESULTS: Post void dribbling (10/19;53%), obstructed flow (7/19;37%), urinary tract infection (4/19;21%), and perineal, scrotal or penile pain (4/19;21%) were the most frequently reported symptoms. Remarkably, the majority reported that these complaints were present for many years prior to seeking attention. A total of 13/19 patients (68%) had an open syringocele while the remaining 6 (32%) were diagnosed with a closed syringocele. All patients with postvoiddribbling had an open syringocele. Five of 7 patients (71%) with an obstructive flow pattern had closed syringoceles. Initial diagnostic work-up in 12/19 patients (63%) included blood samples, urine culture and genitourinary tract ultrasound. Further investigations included: rigid cystoscopy (13/19;68%), cysto-urethrography (12/19; 63%), ultrasound of the perineum (2/19; 11%) and MRI of the prostate or pelvis (5/19;26%). A total of 9/19 patients (47%) opted for conservative treatment. Of the remaining patients who were treated surgically 9 (47%) underwent an endoscopic deroofing of the syringocele with either holmium laser (7/9;78%) or cold knife incision (2/9;22%). Only one patient (1/19;5%) required open urethral surgery. Follow up in the conservatively treated group demonstrated persistence of presenting symptoms in all 9 patients. Of the 10 patients treated surgically, good functional outcomes were demonstrated after both endoscopic and open surgery. CONCLUSIONS: Closed syringoceles are associated with obstructive voiding symptoms and more urinary tract infections. Non-obstructive syringoceles cause more post void dribbling and pain. A diagnostic work-up with uroflowmetry, cystoscopy and cysto-urethrograpy is normally sufficient to diagnose a syringocele. When presentation occurs as a perineal mass, ultrasound and MRI of the perineum are useful modalities as they permit measurement and localization of the cystic dilatation. If conservative treatment fails, endoscopic or open surgery are viable treatment options with good success rates.