Adenoid cystic carcinoma of the urethra/Cowper's gland with concurrent high-grade prostatic adenocarcinoma: a detailed clinicopathologic case report and review of the literature.

Primary adenoid cystic carcinoma of the urethra is uncommon with only 9 cases reported in the medical literature; all tumors arose from Cowper's glands. Herein, we report the histological features and immunohistochemical characteristics of 1 patient with primary adenoid cystic carcinoma involving the entire posterior urethra, prostate gland, corpus spongiosum, corpora cavernosa, urogenital diaphragm, perianal soft tissue, and muscularis propria layer of rectum. We also review other published cases to evaluate the prognosis and treatment.

[Cowper's syringocele as cause of low urinary tract symptoms in a young man].

Cowper's syringocele (CS) is a very rare deformity of male urethra causing obstructive voiding symptoms. This case presents a 39-year-old man suffering from classical low urinary tract symptoms for five years, though without nocturia. The work-up showed normal prostate-specific antigen level, benign conditions by digital rectal examination, and normal-sized prostate on ultrasound. An urodynamic study showed outlet resistance and a supplementary ultrasound of prostate indicated a cyst structure around it. The magnetic resonance imaging confirmed a CS. Marsupialisation is the treatment of choice and was implemented.

Bulbourethral gland adenocarcinoma in a 25-year-old man without comorbidities: radical resection of proximal urethrae with Mitrofanoff-type appendicovesicostomy.

Adenocarcinoma of the paraurethral gland is a rare tumour with no published prevalence in male patients. This report presents a case of bulbourethral gland adenocarcinoma in a 25-year-old man without comorbidities. After resection of the proximal urethra, sphincter and prostate, Mitrofanoff-type appendicovesicostomy was performed. In this case, chemotherapy or radiation was not included in the treatment as the surgery was estimated to be radical. The patient achieved good surgical and quality of life results. This case shows that macroscopic haematuria should be examined even in young age groups without comorbidities.

Giant multicystic cystadenoma of Cowper's gland: a case report.

MAIN FINDINGS: We report what to our knowledge is the first case of a giant multicystic cystadenoma of the Cowper's glands. An otherwise healthy 41-year-old man presented with acute urinary retention. Physical examination showed a perineal mass. Different imaging techniques demonstrated a multicystic tumor and en bloc excision was performed. Histological evaluation showed that the tumor arised from the bulbourethral glands; immunohistochemistry proved positive staining for high molecular weight cytokeratin. CASE HYPOTHESIS: Cystic tumors in the pelvis can arise from different structures. Malignancy should be ruled out. Surgical excision can be diagnostic and curative. Future implications: When evaluating a pelvic cystic tumor, Cowper's glands cystadenoma may be a differential diagnosis and must be considered. Similar to prostate cystadenomas, en bloc excision is the optimal treatment.

[Suprapubic transvesical adenomectomy of external glands of prostate with blind suture of bladder].

The article presents the experience of 524 open suprapubic transvesical prostatectomies with blind suture of bladder and hemostasis of adenoma bed by removable catgut ligatures. The advantages of this type of operation include early recovery of urethral urination (2 to 4th day), the normalization of urodynamic parameters, the restoration of anatomical and functional status of the upper urinary tract (91% of patients), rapid epithelialization of adenoma bed and low incidence of inflammatory and obstructive complications.

Giant multicystic cystadenoma of Cowper's gland: a case report

Main findings We report what to our knowledge is the first case of a giant multicystic cystadenoma of the Cowper's glands. An otherwise healthy 41-year-old man presented with acute urinary retention. Physical examination showed a perineal mass. Different imaging techniques demonstrated a multicystic tumor and en bloc excision was performed. Histological evaluation showed that the tumor arised from the bulbourethral glands; immunohistochemistry proved positive staining for high molecular weight cytokeratin. Case hypothesis Cystic tumors in the pelvis can arise from different structures. Malignancy should be ruled out. Surgical excision can be diagnostic and curative. Future implications When evaluating a pelvic cystic tumor, Cowper's glands cystadenoma may be a differential diagnosis and must be considered. Similar to prostate cystadenomas, en bloc excision is the optimal treatment. .

Cowper's duct ligation for treatment of dysuria associated with Cowper's syringocele treated previously with transurethral unroofing.

A Cowper's duct cyst is a rare entity that occurs most commonly in young men. The current urologic literature supports management with a transurethral unroofing procedure. For patients who present with persistent symptoms associated with a Cowper's syringocele status post-transurethral unroofing, transperineal ligation of the Cowper's duct may be of value in alleviating the symptoms.

A novel technique of bulbourethral sling for post-prostatectomy incontinence.

OBJECTIVE: The treatment of post-prostatectomy incontinence (PPI) can be challenging. Although many injectable materials have been used to treat this problem, the results are at best unsatisfactory. Fixation of an artificial urinary sphincter has been the gold standard of care for patients with PPI for many years. In the last decade there has been a revival of male sling techniques, involving either a fixed or dynamic compressive effect. Herein, a technique for the correction of PPI is described which involves minimal incursion of exogenous material and has excellent cost-effectiveness. MATERIAL AND METHODS: A total of 23 patients underwent a bulbourethral sling procedure using mesh suspended from the anterior abdominal wall for the management of PPI. The technique is performed under spinal anesthesia and utilizes knitted polypropylene mesh, which is fastened by three pairs of sutures. A modified Stamey needle is used for transferring nylon sutures to the suprapubic wound. The sutures are tied in front of the rectus sheath, utilizing intraoperative urodynamic guidance. A 12 F suprapubic tube is utilized as a pressure channel for monitoring vesical pressure and sling tension. RESULTS: Twenty patients were completely dry at the last follow-up, one was greatly improved and in two the treatment was considered a failure. The median follow-up period was 9 months (range 6-24 months). No urethral erosion has been reported thus far. Morbidity in the form of perineal pain and limited ambulation in the first few days after surgery were reported. Five patients had scrotal and penile numbness which continued for an average of 3 months. CONCLUSIONS: The mesh sling technique described herein is efficient and cost-effective. It yielded promising results in this study, which involved a short-term follow-up period and a limited number of patients. More cases are being enrolled and a study involving a longer follow-up period is underway.

Case report: Cowper's syringocele treated with Holmium:YAG laser.

A syringocele is a cystic dilation of Cowper's duct. We report on a 15-year-old boy with persistent dysuria attributable to a syringocele, which was treated by endoscopic unroofing with the holmium:YAG laser. The classification, pathophysiology, and management options of Cowper's syringocele are briefly reviewed.

Bulbar urethroplasty with dorsal onlay buccal mucosal graft and fibrin glue.

OBJECTIVES: We describe a new surgical technique with the use of fibrin glue for bulbar urethra reconstruction using a dorsal buccal mucosal onlay graft. METHODS: Six patients with a mean age of 43 yr underwent bulbar urethroplasty with dorsal onlay buccal mucosal graft and fibrin glue. The urethra was mobilised from the corpora cavernosa and opened along its dorsal surface. The buccal mucosal graft was applied on the corpora cavernosa using 2 ml of fibrin glue. Two interrupted polyglactin 5-0 sutures were used to fix the apices of the graft to the underlying albuginea of the corpora cavernosa. The urethra was rotated back to cover the graft and an adjunctive fibrin glue was injected over the urethra. RESULTS: The mean operative time was 100 min (range, 90-120 min). No intraoperative or postoperative complications were observed. Voiding cystourethrography was performed when the catheter was removed 2 wk after surgery. Urine culture, uroflowmetry, and urethrography were repeated after 6 and 12 mo and annually thereafter. Mean follow-up was 16 mo (range, 12-24 mo). No restrictures at the anastomotic sites were demonstrated in any of the patients 6 and 12 mo after surgery. CONCLUSIONS: The use of fibrin glue represents a slight but significant step toward perfecting the surgical technique of bulbar urethral reconstruction.

Cowper's syringocele--a rare malformation of the male urethra. Erlangen experience in two example cases.

Cowper's syringocele is a cystic dilation of the male urethra which should be surgically treated when symptomatic. Two cases of syringocele, 1 adult and 1 juvenile, with obstructive micturition and microhematuria are reported. Both patients were treated using the transurethral surgical technique. The results are discussed with reference to the relevant literature.

[Imperforate syringocele of the Cowper's glands laparoscopic treatment]. / Siringocele imperforado de las glándulas de Cowper. Tratamiento por vía laparoscópica.

OBJECTIVES: The authors present a clinical report of an imperforate syringocele diagnosed on a male patient and treated by laparoscopic surgery. MATERIAL AND METHODS: A forty-four year old patient attends the emergency room with acute urinary retention. With a former history of mild obstructive voiding symptoms, he presented, at rectal examination, a bump on the left rectal wall. This patient also underwent urethrocistoscopy, sonography and retrograde urethrography. To establish the diagnose, Computerized Tomography (CT) scan and MRI were used. RESULTS: The syringocele marsupialization by laparoscopic surgery, allowed the resolution of the clinical problem, with a good outcome. The patient was discharged 48 hours after surgery, with no need of a vesical catheter. A six month follow-up showed no recurrence. CONCLUSIONS: The syringocele is a rare deformity which usually is asymptomatic. Of acquired or congenital etiology, it can be classified in four different morphological types: simple, perforate, imperforate and ruptured. The most frequent treatment is the marsupialization of the syringocele by endoscopic surgery, leaving a broad opening of the cavity to the urethra. Some authors recommend an open surgery excision, specially in the presence of an abscess. The laparoscopic approach becomes a minimally invasive alternative with good therapeutically outcome. In the incidentally discovered asymptomatic patients, an expectant approach is the correct approach.

Cowper's gland duct cyst in an adult male. Radiological and clinical aspects.

A 48-year-old man presenting with perineal pain, weak stream and dysuria was found to have a Cowper's gland duct cyst measuring 1.8 x 3.5 cm, which was investigated with retrograde and voiding urethrography, cavernosography and perineal MRI, which was the single most useful imaging technique. Treatment consisted in complete surgical excision, which allowed an anatomical reconstruction of the urethra. This condition is typical of the pediatric age group, and seldom diagnosed in adults.

Collection of seasonally spermatozoa-rich semen by electroejaculation of laboratory woodchucks (Marmota monax), with and without removal of bulbourethral glands.

Male woodchucks were subjected to electroejaculation during the early- or mid-breeding season by a commercial stimulator and rectal probe (1.3 x 13 cm, with longitudinal electrode strips on one side) with electrodes oriented ventrally. A study of the voltage and stimulation parameters at a probe depth of 4 to 9 cm suggested that a series of 15 to 75 3-sec pulses of 3 to 6 V each could result in ejaculation and collection of semen. Pulses of only 1 to 2 V frequently caused erection but not ejaculation. Trials conducted on 12 bulbourethral (Cowper's) gland-intact males (n = 18 trials) versus six males from which Cowper's glands had been surgically removed (n = 18 trials) identified these glands as the source of urethral plugs in 77% of ejaculates from the gland-intact males and presumably the source of copulation plugs obtained from the vagina of female woodchucks. The fluid portion of ejaculates from both groups contained few or no spermatozoa. An additional 32 trials were conducted on 12 gland-intact males and eight males without Cowper's glands. These trials included 16 shallow (5 to 8 cm) versus 16 deep (10 to 13 cm) placements of the tip of the rectal probe in each group of males. In gland-intact males the stimulation of sacral (shallow) elements routinely resulted in the emission of large (200 to 300 microl) urethral plugs and fluid volume of 40 to 400 microl, containing few or no spermatozoa. In males without Cowper's glands the sacral stimulation typically produced volumes of 60 to 350 microl of noncoagulating liquid without urethral plugs, containing few or no spermatozoa. Lumbar (deep) stimulation in both groups of males usually resulted in fluid ejaculates, with 60% containing numerous spermatozoa (typically, 0.5 to 3 x 10(6)/ejaculate). Lumbar stimulation usually produced urethral plugs of little (50 to 100 microl) or no volume in gland-intact males and no urethral plugs in males without Cowper's glands. Ejaculates did not coagulate during handling or storage for 4 to 24 h. Serial lumbar stimulation of six males at 2- to 3-week intervals resulted in few spermatozoa, except for a 4- to 8-week period during which > or =0.25 x 10(6) spermatozoa/ejaculate and peaks of 5.3 +/- 2.4 x 10(6) spermatozoa/ejaculate were obtained. The results suggest that electroejaculation can be used to obtain spermatozoa-containing liquid that might be useful for semen evaluation or artificial insemination in laboratory woodchucks, that Cowper's glands are the source of urethral plugs in the ejaculates of this species, and that the fertile period of the male breeding season is limited to 4 to 8 weeks.

[Cowper's syringocele in children: report on ten cases]. / Il siringocele delle ghiandole di Cowper in età pediatrica. A proposito di 10 osservazioni.

Cystic dilatation of Cowper's gland ducts (Cowper's syringocele) is uncommon in pediatric age. Cowper's syringocele frequently are asymptomatic, sometimes may cause dysuria, pollakiuria and obstructive voiding symptoms. We report ten children with syringocele. Five were observed for recurrent urinary infections, three for obstructive voiding symptoms and two for post-traumatic hematuria and for urinary incontinence. Only three patients with obstructive urethral symptoms were surgically treated. In our opinion careful clinical, radiologic and endoscopic evaluation is necessary in such cases so that unnecessary surgery can be avoided.

[Syringoceles of Cowper's glands in children]. / Siringoceles de las glándulas de Cowper en niños.

Some tubular or cystic diverticula observed in the ventral wall of the male bulbous urethra that originate from dilatation of Cowper's gland ducts have been termed "syringoceles". They can cause dysuria, hematuria and obstruction. We report 14 syringoceles and 1 true diverticulum from segmental absence of spongious urethra. We review embryology, anatomy and diagnosis in order to determine the best therapeutic approach. We performed endoscopic resection of the distal valve-like border of the diverticulum in 6 patients (42.85%) with good results. The remaining 8 patients, in whom surgery was not indicated, were followed clinically and radiologically.

Pronounced dilatation of Cowper's gland duct manifest as a perineal mass: a recommendation for management.

It is generally accepted that large dilatations of Cowper's gland duct presenting as a perineal mass should be managed by perineal excision. Experience with such a case suggests that if the lesion also is visualized endoscopically, transurethral unroofing should be the initial choice of management.

Cowper's syringocele causing incontinence in an adult.

We report on a man with post-void incontinence owing to a dilated Cowper's duct (syringocele), which was cured by endoscopic marsupialization. The clinical, radiographical and pathophysiological features of Cowper's lesions are reviewed briefly.