Cowper's Gland Syringocele and Left Ureteropelvic Junction Obstruction: A Case Report of Simultaneous Surgical Treatment by Urethrocystoscopy and Laparoscopy in a 6-Month-Old Infant.

Background: Cowper's gland syringocele is a rare cystic dilation of the male bulbourethral gland, predominantly observed in children and young adults. The simultaneous occurrence of Cowper's gland syringocele and ureteropelvic junction obstruction (UPJO) is exceedingly rare, with only two cases reported in literature. This report presents a novel case involving a 6-month-old male infant, highlighting the first instance of combined minimally invasive surgical treatment within a single anesthetic event.

Case presentation: A 6-month-old male presented with progressive left hydronephrosis and urethral stenosis. Imaging studies confirmed the diagnosis of Cowper's gland syringocele and left UPJO. A unique approach was adopted, involving simultaneous performance of urethrocystoscopy and laparoscopic pyeloplasty under a single anesthetic. The urethrocystoscopy revealed a bulge in the bulbar urethra consistent with syringocele, which was treated by transurethral incision, followed by a laparoscopic Anderson-Hynes dismembered pyeloplasty using minilaparoscopic instruments. The postoperative course was uneventful, and the patient was discharged on the second day, with follow-up showing preserved renal function, significant reduction in hydronephrosis and resolution of the ureteropelvic junction obstruction. The patient remained asymptomatic after 5 years of follow-up.

Conclusions: This case underscores the feasibility and safety of combining urethrocystoscopy and laparoscopic pyeloplasty in a single anesthetic session, even in an infant. The successful outcome in this patient highlights the potential for minimally invasive surgery to treat complex pediatric urological conditions effectively whilst minimising the burden of multiple surgeries.