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Cyst in Cowper's Gland

From: A patient's mom (name withheld)
Date: Wednesday, June 28, 2022 4:14 PM
Subject: Cowper's cyst
My son has just been diagnosed with a cyst on one of his Cowper's glands. His doctor is not sure how to treat him as he has never seen this before. Do you know of any treatment or of anyone who might be experienced with this diagnosis?
Thank you
From: jdimitrakov@my-deja.com
Cowper's glands lie in the DEEP PERINEAL POUCH (superior to the perineal body) and are distinguished by their course parallel to the urethra. The urethra at that part called membranous urethra is in the form of the OMEGA SIGN which means that the internal sphincter muscle of the urethra does not cover the posterior part of the urethra which is therefore named membranous (for its predisposition to be easily injured).To describe this, imagine a ring with a stone on it - the stone points backwards and that is where there are no muscles around the urethra. This is the place most frequently injured during cystoscopy and any instrumental intervention.
The imaging modality of choice for cysts in this space is perineal (transrectal, coiled MRI).Alternatively, retrograde and voiding urethrography, cavernosography can be used.
Patients should NEVER try to drain those cysts since they run PARALLEL to the urethra but in the opposite direction. That is my main concern with spousal or self-drainage - those unaware of the anatomy can easily hurt the membranous urethra trying too hard to push out the secretions. I suggest that anyone trying to do drainage should be educated how to do it first.
Rupture of the cysts can result in an infection of the deep perineal space which is a very serious complication.
Treatment of choice for Cowper gland cysts known as "syringocele" is surgical transurethral resection of the cysts together with urethral reconstruction.
Best regards, Jordan Dimitrakov, MD

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