Anterior urethral valves and diverticula in children: a result of ruptured Cowper's duct cyst?

The experience from Boston in anterior urethral valves and diverticula over a 40‐year period is described. Other articles describe experience with both ignoring and treating VUR, and ballooning of the foreskin and physiological phimosis. OBJECTIVE To review a series of children with anterior urethral valves and diverticula, to elucidate the pathophysiology and optimal management of this entity. PATIENTS AND METHODS Nine cases (all boys; 1963 to 2003) were reviewed retrospectively. RESULTS Seven of nine boys had bulbar diverticula. Continuity between Cowper's duct and the diverticulum was noted endoscopically in two and confirmed radiographically in one. Initially, open surgery was curative but more recently endoscopic management has been the procedure of choice. CONCLUSION This series indicates that the distal lip of a ruptured syringocele may function as a flap‐valve, leading to anterior urethral obstruction. Advances in imaging and endoscopic instruments have altered the mode of presentation and management of this entity.