Cowper’s Duct Syringocele Mimicking Prostatic Obstruction: A Case Report

Introduction: Cowper’s glands, also known as bulbourethral glands, were first described by French surgeon Jean Mery in 1684 and later detailed by William Cowper in 1699. Cowper’s duct syringocele, a rare condition involving cystic dilatation of Cowper’s gland, can mimic symptoms of prostatic obstruction, posing diagnostic challenges. Common presentations include lower urinary tract symptoms (LUTS) such as urgency, weak stream, and incomplete emptying, often leading to misdiagnosis as benign prostatic hyperplasia (BPH). Accurate diagnosis involves imaging studies like transrectal ultrasound (TRUS) and magnetic resonance imaging (MRI), along with retrograde urethrography and cystourethroscopy. Management varies from conservative measures to surgical intervention, depending on symptom severity. Case Presentation: A 36-year-old male presented with urinary obstruction symptoms, reporting a poor stream and straining to urinate over three months, with exacerbation characterized by incomplete voiding. No hematuria, UTIs, or urolithiasis history was noted. Examination was largely unremarkable, except for a flat prostate on per rectal examination. Uroflowmetry indicated a maximum flow rate (Qmax) of 15 ml/sec with an interrupted pattern. MRI revealed a cystic lesion in the posterior urethra, raising suspicion for Cowper’s duct syringocele. Diagnostic cystoscopy confirmed the cystic dilatation, which was deroofed using monopolar energy. The patient’s recovery was uneventful, with follow-up uroflowmetry showing significant improvement, with a Qmax of 27 ml/sec. Discussion: This case underscores the importance of considering Cowper’s duct syringocele in the differential diagnosis of LUTS, especially in patients with atypical presentations. The diagnostic approach included uroflowmetry, MRI, and cystoscopy, which confirmed the cystic lesion. Management involved transurethral deroofing, leading to symptom resolution and improved urinary flow. Early recognition and intervention are crucial for favorable outcomes. Literature highlights the role of imaging and endoscopic techniques in diagnosing and managing this rare condition, emphasizing the need for interdisciplinary collaboration in complex urological cases. Conclusion: This case emphasizes the need for considering Cowper’s duct syringocele in patients with LUTS to avoid misdiagnosis and inappropriate management. Accurate diagnosis through a combination of uroflowmetry, imaging, and cystoscopy, followed by appropriate