Imaging of the Bulbourethral (Cowper) Gland: Abnormalities and Differential Diagnosis.

Normal Cowper glands and ducts are imperceptible at imaging. However, abnormalities of the Cowper glands and ducts are increasingly seen owing to increasing use of cross-sectional imaging. In this article, the authors present a comprehensive review of the normal anatomy of the Cowper glands and ducts and the clinical and imaging findings of conditions that affect them in an effort to help lead to appropriate diagnosis and management. A Cowper duct syringocele is a congenital or acquired dilatation of the Cowper duct in the bulb of the corpus spongiosum. Retrograde urethrography is the standard test to diagnose a communicating (open) Cowper duct syringocele, and MRI is used for further morphologic assessment. Cowperitis refers to inflammation of the gland and/or duct, and recurrent cowperitis is usually associated with an underlying syringocele, a urethral fistulous connection to the Cowper gland, or a perianal fistula. MRI allows detection of the underlying structural abnormality and the superimposed inflammation. Cowper stones are typically radiopaque and are found in both the Cowper gland and duct. A Cowper gland hemorrhagic cyst may be incidentally detected at MRI of the prostate, and follow-up MRI may be required to ensure evolution of hemorrhage and exclude an underlying neoplasm. Cowper gland carcinoma is rare and includes adenocarcinoma and adenoid cystic carcinoma subtypes. Transperineal US may be used for initial evaluation and CT and/or MRI are necessary for further characterization and staging. Cowper gland hyperplasia is a rare entity with few previous reports that may be incidentally detected at imaging and may mimic malignancy. ©RSNA, 2022.

What urethrogram sees and a surgeon does not. / Lo que una uretrografía ve y un cirujano no.

INTRODUCTION: Urethrorrhagia is an infrequent sign in childhood. It should be distinguished from hematuria, since they have a different etiology. CLINICAL CASE: 11-year-old male patient with significant urethrorrhagia. Urinary sediment analysis: red blood cells++. Pelvic ultrasonography: fusiform anechoic image in the corpus spongiosum of the penile root. Retrograde urethrogram: normal anterior urethra, extraluminal contrast passage in the ventral aspect of the bulbar urethra. Cystoscopy: no pathological findings in the urethra or the bladder. Control retrograde urethrogram: cystic dilatation of Cowper's gland duct; Maizels' type 3 perforated syringocele. DISCUSSION: Cowper's syringocele is a rare pathology. It can occur at any stage of childhood in the form of urinary infection, obstructive voiding symptoms, or urethrorrhagia. Urethrogram is key for diagnostic purposes, since most Cowper's syringoceles are detected following urethrogram or cystoscopy. Cases with functional repercussions for the urinary system require surgical treatment. Otherwise, a wait-and-see approach is feasible.

INTRODUCCION: La uretrorragia es un signo infrecuente en la infancia que debe distinguirse de la hematuria dada la diferente etiología de las mismas. CASO CLINICO: Varón de 11 años con uretrorragia franca. Sedimento urinario: hematíes++. Ecografía pélvica: imagen anecoica fusiforme en cuerpo esponjoso de raíz peneana. Uretrografía retrógrada: uretra anterior normal, paso de contraste extraluminal ventral en uretra bulbar. Cistoscopia: sin hallazgos patológicos en uretra ni vejiga. Uretrografía retrógrada de control: dilatación quística del conducto de las glándulas de Cowper; siringocele perforado tipo 3 de Maizels. COMENTARIOS: El siringocele de Cowper es una patología infrecuente que puede debutar en cualquier momento de la infancia como infección urinaria, síntomas miccionales obstructivos o uretrorragia. La uretrografía es fundamental en su diagnóstico ya que la mayoría se objetivan por este medio o cistoscopia. Los casos con repercusión funcional del sistema urinario requieren tratamiento quirúrgico. En caso contrario podrá realizarse actitud expectante.

Lo que una uretrografía ve y un cirujano no / What urethrogram sees and a surgeon does not

Introducción: La uretrorragia es un signo infrecuente en la infancia que debe distinguirse de la hematuria dada la diferente etiología de lasmismas. Caso clínico: Varón de 11 años con uretrorragia franca. Sedimento urinario: hematíes++. Ecografía pélvica: imagen anecoica fusiforme en cuerpo esponjoso de raíz peneana. Uretrografía retrógrada: uretra anterior normal, paso de contraste extraluminal ventral en uretra bulbar.Cistoscopia: sin hallazgos patológicos en uretra ni vejiga. Uretrografíaretrógrada de control: dilatación quística del conducto de las glándulasde Cowper; siringocele perforado tipo 3 de Maizels.Comentarios: El siringocele de Cowper es una patología infrecuente que puede debutar en cualquier momento de la infancia como infección urinaria, síntomas miccionales obstructivos o uretrorragia.La uretrografía es undamental en su diagnóstico ya que la mayoría se objetivan por este medio o cistoscopia. Los casos con repercusión funcional del sistema urinario requieren tratamiento quirúrgico. En caso ontrario podrá realizarse actitud expectante.

Introduction: Urethrorrhagia is an infrequent sign in childhood. It should be distinguished from hematuria, since they have a different etiology.Clinical case: 11-year-old male patient with significant urethror-rhagia. Urinary sediment analysis: red blood cells++. Pelvic ultrasonog-raphy: fusiform anechoic image in the corpus spongiosum of the penileroot. Retrograde urethrogram: normal anterior urethra, extraluminal con-trast passage in the ventral aspect of the bulbar urethra. Cystoscopy: nopathological findings in the urethra or the bladder. Control retrograde urethrogram: cystic dilatation of Cowper’s gland duct; Maizels’ type 3perforated syringocele.Discussion: Cowper’s syringocele is a rare pathology. It can occurat any stage of childhood in the form of urinary infection, obstructivevoiding symptoms, or urethrorrhagia. Urethrogram is key for diagnos-tic purposes, since most Cowper’s syringoceles are detected followingurethrogram or cystoscopy. Cases with functional repercussions for theurinary system require surgical treatment. Otherwise, a wait-and-seeapproach is feasible

Cowper's gland hyperplasia: A potential pitfall at MRI of the prostate.

MRI features are presented in a multicenter retrospective series of five patients with a unilateral masslike lesion seen in the genitourinary diaphragm at MRI performed for known or suspected prostate cancer. In all cases, the lesion appeared as an encapsulated 1.3 to 3.0 cm mass of heterogeneous low or intermediate T2 signal intensity in the genitourinary diaphragm, and targeted biopsy demonstrated benign Cowper's gland tissue. This entity is a potential imaging pitfall that could result in a diagnosis of an exophytic nodule of benign prostatic hyperplasia or local spread of prostate cancer. We present these cases to facilitate correct identification of Cowper's gland hyperplasia as an occasional finding at MRI of the prostate.

The Role of Male Reproductive Organs in the Transmission of African Swine Fever-Implications for Transmission.

African swine fever (ASF) has evolved from an exotic animal disease to a threat to global pig production. An important avenue for the wide-spread transmission of animal diseases is their dissemination through boar semen used for artificial insemination. In this context, we investigated the role of male reproductive organs in the transmission of ASF. Mature domestic boars and adolescent wild boars, inoculated with different ASF virus strains, were investigated by means of virological and pathological methods. Additionally, electron microscopy was employed to investigate in vitro inoculated sperm. The viral genome, antigens and the infectious virus could be found in all gonadal tissues and accessory sex glands. The viral antigen and viral mRNAs were mainly found in mononuclear cells of the respective tissues. However, some other cell types, including Leydig, endothelial and stromal cells, were also found positive. Using RNAScope, p72 mRNA could be found in scattered halo cells of the epididymal duct epithelium, which could point to the disruption of the barrier. No direct infection of spermatozoa was observed by immunohistochemistry, or electron microscopy. Taken together, our results strengthen the assumption that ASFV can be transmitted via boar semen. Future studies are needed to explore the excretion dynamics and transmission efficiency.

Persistent Dysuria in a Young Male.

A Cowper's Duct syringocele is a rare diagnosis and currently there exists no clinical guidelines for evaluation and management. This clinical challenge illustrates the case presentation, evaluation, diagnosis, and treatment options for of a newly diagnosed Cowper's Duct syringocele.

The effects of different dietary protein sources on live weight, sperm quality and the histology of the testes and accessory glands in male rats.

This study was aimed at determining the effects of corn and wheat gluten, used as dietary protein sources, on live weight gain, sperm quality and the histology of the testes and accessory glands in male rats. For this purpose, 20-day-old 24 male Wistar albino rats were randomly assigned to three groups. Group 1 (Control), Group 2 and Group 3 were fed on a basal ration supplemented with high levels of soybean meal, corn gluten and wheat gluten, respectively, as a protein source. At the end of the study, when compared to Group 1, live weight values were determined to have increased in Group 3 and to have decreased in Group 2 (p < .05). Furthermore, sperm density, sperm motility, the dead/ live sperm ratio and testes weight were determined to have significantly decreased in Group 2, in comparison to Groups 1 and 3 (p < .05). The percentages of abnormal spermatozoon, and head, acrosome, mid-piece and tail abnormalities were high in Group 2 (p < .05). Histological examination demonstrated that, in Group 2, the diameter of the Tubulus Seminiferous Contortus (TSC) and the size of the Tubular Epithelial Cells (TE) were small, and the tubular and anatomical structure of the testes were shrunken and altered. Group 2 also presented with connective tissue increase and alveolar lumen enlargement in the prostate gland, and with connective tissue thickening, muscle tissue increase and secretory capacity decrease in the seminal vesicle (p < .05). Moreover, in Group 2, the Gl. Bulbourethral (Cowper's gland) presented with a decreased size and dilatations in the mucous structures. In a result, based on the findings obtained in this study, it is suggested that high levels of dietary corn gluten adversely affect live weight, sperm quality, and the testes and accessory glands.

Syringoceles of Cowper's ducts and glands in adult men.

Cowper's syringoceles are uncommon, usually described in children and most commonly limited to the ducts. We describe more complex variants in an adult population affecting with varying degrees of severity, the glands themselves, and the complications they may lead to. One hundred consecutive urethrograms of patients with unreconstructed strictures were reviewed. Twenty-six patients (mean age: 41.1 years) with Cowper's syringoceles who were managed between 2009 and 2016 were subsequently evaluated. Presentation, radiological appearance, treatment (when indicated), and outcomes were assessed. Of 100 urethrograms in patients with strictures, 33.0% demonstrated filling of Cowper's ducts or glands, occurring predominantly in patients with bulbar strictures. Only 1 of 26 patients with non-bulbar strictures had a visible duct/gland. Of 26 symptomatic patients, 15 presented with poor flow. In four patients, a grossly dilated Cowper's duct obstructed the urethra. In the remaining 11 patients, a bulbar stricture caused the symptoms and the syringocele was identified incidentally. Eight patients presented with perineal pain. In six of them, fluoroscopy and magnetic resonance imaging (MRI) revealed complex multicystic lesions within the bulbourethral glands. Four patients developed perineoscrotal abscesses. In the 11 patients with strictures, the syringocele was no longer visible after urethroplasty. In three of four patients with urethral obstruction secondary to a dilated Cowper's duct, this resolved after transperineal excision (n = 2) and endoscopic deroofing (n = 1). Five of six patients with complex syringoceles involving Cowper's glands were excised surgically with symptomatic relief in all. In conclusion, Cowper's syringocele in adults is more common than previously thought and may cause lower urinary tract symptoms or be associated with serious complications which usually require surgical treatment.

Syringocele: a retrospective study and review of the literature.

Background: A syringocele is a cystic dilation of the ducts from the bulbourethral glands located in the bulbous part of the male urethra. It is a rare condition primarily reported in children and young adults. The objective was to evaluate the diagnostic pattern and management strategy in patients of all ages diagnosed with syringocele.Methods: A retrospective review of patients with syringocele in the period 2004-2018 was performed. Age at diagnosis, primary symptoms, the diagnostic modalities used, treatments and effects were registered.Results: In the period, 19 patients with syringoceles were identified, eight children and 11 adults. The majority of the patients presented with obstructive voiding symptoms. All patients underwent cystourethroscopy. Supplementary diagnostics as voiding cystourethrography, retrograde urethrography, uroflowmetry, magnetic resonance imaging or transrectal ultrasonography were used inconsistently. Sixteen of the patients underwent marsupialization, one child underwent open excision and two patients were managed conservatively. Three of the children were re-operated on with endoscopic marsupialization. One of the adult patients did not respond to marsupialization and was treated with and vesico-appendico-cutaneostomy.Discussion: A review of the case reports published in the period 1996-2018 was performed and compared to these results. This review found 77 cases, 50 children and 27 adults. The reported symptoms, diagnostics and treatments were in line with the findings of this study.Conclusions: Based on these findings and the literature it is recommended that syringoceles should be diagnosed by cystourethroscopy and urethrography. Patients with symptomatic syringoceles should be offered treatment. First line treatment is endoscopic marsupialization.

Cowper's syringocele in the pediatric population: a retrospective study of 122 patients.

INTRODUCTION AND OBJECTIVE: 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. The authors analyzed to clarify the clinical manifestation, diagnostic approach, management, and incidence in the pediatric population. MATERIALS AND METHODS: All patients (122 cases) diagnosed with a syringocele at the department of Pediatric Urology in a tertiary referral university children's hospital between August 1991 and October 2016 were analyzed retrospectively by assessing medical charts. RESULTS: The clinical manifestation, diagnostic findings, and follow-up are summarized in the table. Half of the patients (50.0%) also had typical posterior urethral valves (PUVs) and/or a single valve in the 12 o'clock position (flap-valve). The symptoms of open and closed syringoceles showed no significant difference. Treatment consisted of incision of the syringocele with a diathermia hook. The incidence of urinary tract infection (UTI) before and after surgery in the group that had a syringocele only was significant different. The overall incidence of syringoceles seen at urethrocystoscopy in this series was 3.0%. DISCUSSION: This series suggests that the presenting age is strongly related to the consequences of syringoceles, as the youngest half of the patients had significantly more UTIs at presentation than older patients, who presented with significantly more obstructive voiding symptoms, postvoiding residuals, and incontinence. In addition, the younger group had a significantly higher incidence of vesicoureteral reflux and dilatation of the upper urinary tract. The found association between syringoceles and PUV may be due to overgrowth of epithelium, as possible origin in both anomalies. CONCLUSION: With an incidence of 3.0%, syringoceles, in this tertiary referral series, should be considered in the differential diagnosis of obstructive urethral lesions. The presentation ranges between signs of severe obstructions in the prenatal and postnatal period to mild urinary incontinence problems at later age. Urethrocystoscopy proved to be useful in confirming the diagnosis and allows for immediate transurethral incision.

Chlamydia pecorum Infection in the Male Reproductive System of Koalas ( Phascolarctos cinereus).

Chlamydiosis is the most documented and serious disease of koalas, characterized by ocular, urinary, and reproductive lesions. Since little attention has been paid to the pathological effects of this infection in the male reproductive system, we aimed to determine the incidence and severity of reproductive pathology associated with chlamydial infection in male koalas submitted to koala hospitals in southeast Queensland. The entire reproductive tract from 62 sexually mature male koalas not suitable for rehabilitation was evaluated and 677 tissue samples were collected for histology, immunohistochemistry (IHC), and real-time polymerase chain reaction (qPCR). Lymphoplasmacytic inflammation was observed in 178 of 677 (26.3%) tissue samples from the upper and lower reproductive tract, mainly in the prostatic, penile, and membranous urethra. IHC was positive for the chlamydial antigen in 19 of 451 normal samples (4.2%) and 46 of 178 samples with inflammation (25.8%), located within the cytoplasm of epithelial cells of the epididymis, vas deferens, prostate, bulbourethral glands, and the prostatic membranous and penile urethra. Chlamydia pecorum was detected via qPCR in 319 of 451 normal samples (70.7%) and 159 of 178 samples with inflammation (89.3%), with the highest incidence in the penile urethra, prostate, membranous urethra, and bulbourethral glands. This study suggests that Chlamydia infection in the male reproductive tract is more widespread than originally thought. Furthermore, the male reproductive tract might be a reservoir for persistent chlamydial infections in koalas, with important implications for prophylactic strategies and epidemiology.

Cowper's Gland Syringocele.

Cowper's gland syringoceles are rare cystic dilations of the Cowper's gland duct. They are typically diagnosed in childhood but occasionally occur in adults. We report the case of a 28-year-old man who presented with a painful perineal and inferior scrotal mass and was found to have a large Cowper's gland syringocele extending into the scrotum associated with a scrotal abscess. Treatment consisted of surgical excision. The magnetic resonance imaging findings of this case are described.

Cowper's syringocele: A rare differential diagnosis of infravesical obstruction in boys and young adults.

OBJECTIVE AND INTRODUCTION: Cowper's syringocele is a cystic dilation of the bulbourethral gland duct, initially defined by Maizels et al. in 1983. Although obstructive and non-obstructive types of this rare anomaly are described, clinical symptoms are highly unspecific. Therefore, we report 12 cases of children and young adults diagnosed with Cowper's syringocele to further clarify clinical course, comorbidity and treatment strategies. STUDY DESIGN: We retrospectively collected clinical data of 12 children and young adults from birth to 18.5 years (median 7.2 years) who had been treated in four different institutes during a period of 16 years. The primary specific diagnostic work-up consisted of ultrasound, cystourethrography, and cystoscopy. RESULTS: 3Older patients with a median age of 11.8 years clinically presented with obstructive voiding pattern or gross hematuria; infants with a median age of 0.6 years presented with febrile urinary tract infections (UTIs). After cystoscopic confirmation in all patients, endoscopic treatment was possible in nine; open surgical resection was necessary in three patients. Because of intrauterine megacystis and chronic renal failure, one boy underwent suprapubic diversion with a cystostomy soon after birth. Owing to urological comorbidity or later complications, additional procedures were necessary, for example, resection of minor urethral valves, prophylactic circumcision for UTI, endoscopic or open antireflux procedures, and occasionally complex bladder reconstructions in the long term. DISCUSSION: According to our data, the initial clinical symptoms of Cowper's syringocele were related to presenting age rather than the previously described type of syringocele according to Maizels et al. Infants presented with febrile UTIs; however, older boys and young adults had mainly voiding problems or nocturnal enuresis. Therefore, the clinical significance of the described syringocele types must be questioned. Eighty-three percent of our patients showed additional urological pathology such as vesicoureterorenal reflux, ureteropelvic junction obstruction, megaureter, or minor urethral valves. Thus, Cowper's syringocele hardly seems to be an isolated pathology. CONCLUSION: Although rare, Cowper's syringoceles should be considered in differential diagnosis of infravesical obstruction in boys and young adults. Diagnostics are usually justified by presenting symptoms such as UTI or urinary flow impairment, which seem to be age dependent. Despite modern diagnostic tools, diagnosis is usually made by cystourethrography and sometimes accidentally by cystoscopy. Considerable urological comorbidities and consecutive bladder dysfunction need long-term follow-up.

Presencia o ausencia de espermatozoides en el líquido preeyaculatorio / Presence or absence of sperm in the pre ejaculatory fluid

Objetivo. Determinar la presencia o ausencia de espermatozoides en el líquido preeyaculatorio. Material y métodos. Estudio descriptivo, transversal, realizado en 25 varones universitarios, voluntarios, entre 18-25 años en Barranquilla, Colombia. A cada sujeto se le entregaron 2 portaobjetos para la toma del líquido preeyaculatorio y un recipiente para la toma de muestra del líquido seminal; se tomó primero y por autoestímulo la muestra preeyaculatoria y posteriormente la muestra para el espermiograma; la búsqueda de espermatozoides en el líquido preeyaculatorio se realizó en al menos 10 campos a un aumento de ×20 y en los 2 portaobjetos. El líquido seminal se procesó según normas de la OMS. Resultados. Los líquidos preeyaculatorios examinados no tenían espermatozoides. Todos los sujetos del estudio tenían espermiogramas con recuento total de espermatozoides superiores a 100 millones de espermatozoides, una movilidad superior al 50%; el pH promedio fue de 8,2±0,5. Conclusiones. El líquido preeyaculatorio secretado por las glándulas de Cowper y Littre durante la estimulación sexual no contiene espermatozoides, siempre que haya al menos 2 días de abstinencia eyaculatoria previa y, por lo tanto, no puede ser responsable de los embarazos ocurridos en la práctica del contacto sexual del pene sobre los genitales externos femeninos ni en la práctica del coito interrumpido como método anticonceptivo (AU)

Objective. To determine the presence or absence of sperm in pre ejaculate fluid. Material and methods. A descriptive, cross-sectional study in 25 college male volunteers, aged between 18 and 25 in Barranquilla (Colombia). Each subject was given two slides for making pre-ejaculatory fluid and a container for sampling of seminal fluid; pre-ejaculatory sample was taken first by self-stimulation, and subsequently the sample for semen analysis was collected. Search for sperm in pre-ejaculatory liquid was held in at least 10 fields at ×20 magnification and the two slides. The seminal fluid was processed according to WHO standards. Results. None of the pre-ejaculatory fluids examined had sperm. All study subjects had spermiograms with total count in excess of 100 million sperm mobility greater than 50%; the average pH was 8.2±0.5. Conclusions. Pre-ejaculatory fluid secreted by the glands of Cowper and Littre during sexual stimulation, does not contain sperm and therefore cannot be responsible for pregnancies occurring in the practice of sexual intercourse where the penis is in contact with the external female genitalia or in practice of withdrawal as a contraceptive method (AU)

Multicystic degeneration of the Cowper's gland in a Large White boar.

The present report describes a case of multicystic degeneration of the Cowper's gland in a 1.3-year-old purebred Large White intact boar with reduced fertility in Switzerland. Based on the case history, a general physical examination, an andrological investigation and a transrectal ultrasonography combined with a subsequent thorough pathological examination including histology a multicystic degeneration of the Cowper's gland were diagnosed. The case indicates that cystic degeneration of the bulbourethral gland should be contemplated in the differential diagnoses of andrological disorders even though it has not been described in pigs so far. While selecting breeding boars, a morphological check of the bulbourethral gland can be performed, since degeneration of the gland would potentially have an impact on future fertility.

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.

A case report of Cowper's syringocele in an 18-months old infant at the Yaoundé Gynaeco-Obstetric and Pediatric Hospital.

Syringocele or dilatation of the duct of the bulbo-urethral (Cowper's) gland is usually of congenital origin but can be acquired. It is a very rare deformity, <10 cases have been reported in literature. The main objective is to describe an additional case of syringocele of Cowper's glands and review the literature. An 18-month-old infant presented with a history of acute urinary retention 3 days after birth and a cystostomy was done. Voiding cystourethrogram was normal and cystourethroscopy showed a syringocele. Endoscopic incision was performed in our patient with satisfactory results. No complications were noted. Syringocele or cystic dilatation of Cowper's gland duct usually has a congenital aetiology. Diagnosis is confirmed by endoscopy. Treatment is by marsupialisation in the urethra by endoscopy. Syringocele is a rare pathology usually congenital. It should be suspected in all case of lower urinary tract obstruction in children.

[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.

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.