Abstract
Dear Editor,
We read with interest the recent publication by Patel and Rai: ‘Successful treatment of a rare Cowper’s bulbourethral gland syringocele in an adult with endoscopic laser deroofing using a rigid ureteroscope’. 1
A case is described of a novel technique using a rigid ureteroscope and laser deroofing to treat an imperforate syringocele in a 40-year-old male who presented with lower tract symptoms and recurrent urinary tract infections. 1 The surgical technique and follow up are described, and it is notable that all symptoms resolved with this new approach although no follow up radiology or use of an objective symptom score is mentioned.
The authors are right in their suggestion that Cowper’s gland syringoceles are an increasingly important differential diagnosis to be considered in men who present with lower urinary tract symptoms. They should be considered in young males who present with obstructive or irritative lower tract symptoms, haematuria, urethral discharge or perineal pain and swelling.2,3 Patients with new onset lower tract symptoms and perineal swelling should be asked specifically about recreational activities such as cycling and horse riding, which may increase their risk. Occupations requiring use of ride-on lawn mowers are also at higher risk. 4
The variety of surgical techniques for syringocele management is described, and the authors emphasise that surgical treatment for bothersome symptoms remains the gold standard. 1 Although the majority of treatments described are endoscopic, laser-related open surgery still has a role in the management of syringoceles. 4
Case reports exist of a patient who presented with perineal pain and swelling exacerbated by cycling that eventually required open excision of a closed syringocele following urethrography and magnetic resonance imaging characterisation. 4
The authors are to be commended for describing a novel method of definitive treatment for imperforate syringoceles that required no catheter post operatively. However, they should acknowledge that open urethral surgery still has a role in select cases of closed syringocele treatment.
Footnotes
Acknowledgements
None.
Conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Ethical approval
Not applicable.
Informed consent
Not applicable.
Guarantor
MSF.
Level of Evidence
Not applicable.
Contributorship
TPNH – wrote initial draft, document preparation and submission; AMO – edited the initial draft, read and approved the final document; MSF – identified case as being of interest, assisted in literature search, assisted in the writing of the entire document, read the initial and approved the final document.
