Cowper’s syringocele in the pediatric population: an analysis of 122 consecutive cases
Martijn E. Wagemans, BMSc1, Luitzen A. Groen, MD, FEAPU2, George Tsachouridis, MD, FEAPU1, Caroline F. Kuijper, MD, FEAPU2, Keetje L. de Mooij, MD, FEAPU1, Aart J. Klijn, MD, PhD, FEAPU1, Tom P. de Jong, MD, PhD, FEAPU1.
1University Children's Hospitals UMC Utrecht and AMC Amsterdam, Utrecht, Netherlands, 2University Children's Hospitals UMC Utrecht and AMC Amsterdam, Amsterdam, Netherlands.
BACKGROUND
Syringocele is a rare cystic dilatation of the duct of Cowper’s gland, afflicting mostly the pediatric population. Syringoceles have a wide range of symptoms and may cause urethral obstruction. We analysed 122 cases in order to clarify the clinical manifestation, diagnostic approach, management and incidence in the pediatric population. These 122 cases constitute the largest group of syringoceles reported to date.
METHODS
All patients diagnosed with a syringocele at our department between August 1991 and October 2016 were analysed retrospectively by assessing medical charts.
RESULTS
The overall incidence of syringoceles was 3.0%, based on UCS performed in approximately 4.000 boys over 26 years. The most frequent presenting symptoms were UTI (50.0%) and obstructive voiding symptoms (45.9%). The youngest half of our patients had significantly more UTIs at presentation than older patients, who presented with significantly more obstructive voiding symptoms, post-voiding residuals and incontinence. In addition, the younger group had a significantly higher incidence of VUR and dilatation of the upper urinary tract. UCS revealed 31 open and 83 closed syringoceles. In 8 patients two coexisting syringoceles were found. Approximately half of the patients also had PUV. Treatment consisted of incision of the syringocele with a diathermy hook.
CONCLUSIONS
With an incidence of 3.0%, syringoceles should be considered in the differential diagnosis of obstructive urethral lesions. The presentation ranges between signs of severe obstructions in the pre- and postnatal period to mild urinary incontinence problems at later age. An association between syringoceles and PUV suggests a common origin, which could be overgrowth of epithelium. UCS proved to be diagnostic in confirming the diagnosis, as well as therapeutic in allowing transurethral incision.
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