Cowper’s Glands Abscess with Spreading to Adjacent Organs and Tissues with Development of Septic Shock: An Extremely Rare Case

Abstract

Background

We present here the first case of Cowper’s gland abscess complicated by septic shock and breakthrough of the abscess into the paraurethral region, cavernous body, scrotum, and pararectal tissue.

Case Presentation

A 63-year-old patient was admitted with complaints of temperature increase up to 39°C, pain and enlargement of the perineum and the right half of the scrotum, frequent and difficulty urination, weakness, dizziness, dry mouth, and a sharp deterioration of the general condition. Clinical-laboratory data showed the presence of septic shock with unstable haemodynamics and many concomitant diseases. From the history, it is known that the patient for more than 20 years suffered from urinary tract infection and urinary disorders. Six months earlier, the patient underwent a puncture of a bulbourethral abscess. According to the ultrasound of the scrotum, TRUS, and MRI, bulbourethral abscess with spread to the right half of the scrotum, a part of the cavernous body, and the cellular tissue of the left sciatic-rectal fossa was diagnosed. Purulent cavities were opened with two incisions and drained. A cystostomy was installed. In the intensive care unit, according to a microbiological study (Escherichia coli, Klebsiella pneumoniae, and Klebsiella pneumoniae), antibacterial, detoxification, and symptomatic therapy of concomitant diseases were carried out together with a resuscitator and therapist. The patient was discharged on the 30th day with a negative analysis of urine culture, with a cystostomy, which was removed six months after the independent restoration of urination and closure of the fistulous passage between the urethra and Cowper’s glands.

Conclusion

Untimely treatment of the very rare abscess of the Cowper’s gland can lead to serious complications, up to the spread of a purulent process to neighbouring organs and tissues, and the development of septic shock, which will require urgent and intensive therapy with the involvement of experts from interdisciplinary fields.

Keywords:

• Cowper’s glands abscess
• bulbourethral abscess
• infection
• cowperitis
• septic shock
• complications

Abbreviations

CFU, colony-forming unit; CRP, c-reactive protein; CVC, cardiovascular complications; MRI, magnetic resonance imaging; PSA, prostate-specific antigen; STI, sexually transmitted infection; TRUS, transrectal ultrasound.

Data Sharing Statement

All data generated or analysed during this study are included in this published article.

Consent for Publication

The patient signed consent for publication of data (including individual details and images).

Acknowledgments

The publication has been prepared with the support of the “RUDN University Program 5-100”.

Author Contributions

All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work. All the authors have read and approved the manuscript, and have agreed both to be personally accountable for the author’s own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature.

Disclosure

The authors declare that they have no competing interests.

Additional information

Funding

This study did not receive any specific grants from any funding agencies in the public, commercial, and non-profit sectors.