Cowper duct syringocele

Incidental

findings in and around the prostate on prostate MRI: a pictorial review. Cowper’s gland duct cyst a Axial, (b) coronal and (c) sagittal T2 weighted images show a midline ovoid high T2 signal lesion at the penile base (white arrow) in keeping with a Cowper’s gland duct cyst. The prostate is seen superior to the lesion (red arrow)

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Cowper duct syringocele refers to cystic dilatation of the main duct of the bulbourethral (Cowper) glands.

Clinical presentation

Affected patients may present with postvoid dribbling, urinary frequency, weak stream, or hematuria.

Pathology

Four groups of syringoceles have been described :

simple syringocele
- minimally dilated duct
- most frequent
perforate syringocele
- bulbous duct that drains into the urethra via a patulous ostium
- can appear as a diverticulum
imperforate syringocele: bulbous duct that resembles a submucosal cyst and appears as a radiolucent mass
ruptured syringocele: fragile membrane that remains in the urethra after a dilated duct ruptures

Radiographic features

Ultrasound

May be seen a unilocular cystic lesion at the posterior or posterolateral aspect of the posterior urethra .

MRI

Usually seen as a midline oval structure at the penile base adjacent to the ventral aspect of the proximal bulbous urethra.

T1: low signal intensity
T2: high signal intensity

Treatment and prognosis

Treatment options include surgical incision of the obstructed duct (considered generally curative).

History and etymology

The Cowper glands and ducts were named for William Cowper (1666–1709), an English surgeon, who described the detailed anatomy of the bulbourethral glands in 1699. In actuality, the bulbourethral glands were first described by Jean Méry (1645– 1722), a French surgeon in 1684 . To be fair to Cowper, he never claimed to have discovered his eponymous glands !