What urethrogram sees and a surgeon does not.

Area of Science:

• Pediatric Urology
• Urogenital Diseases
• Diagnostic Imaging

Background:

• Urethrorrhagia is an uncommon pediatric symptom requiring differentiation from hematuria due to distinct etiologies.
• Cowper's syringocele is a rare cause of urethrorrhagia in children.

Observation:

• An 11-year-old male presented with significant urethrorrhagia.
• Diagnostic imaging included pelvic ultrasonography and retrograde urethrogram.
• Cystoscopy revealed no intrinsic urethral or bladder pathology.

Findings:

• Retrograde urethrogram identified extraluminal contrast in the bulbar urethra, consistent with a Maizels' type 3 perforated syringocele.
• The cystic dilatation of the Cowper's gland duct was visualized.

Implications:

• Cowper's syringocele can manifest as urinary tract infections, voiding dysfunction, or urethrorrhagia in children.
• Retrograde urethrogram is essential for diagnosing Cowper's syringocele.
• Management strategies include surgical intervention for functional impairment or a conservative 'wait-and-see' approach.