From the Guidelines
A Cowper's gland abscess or cyst requires prompt medical evaluation by a urologist, with treatment typically involving antibiotics for infection and drainage of the abscess if present. The most recent and highest quality study 1 suggests that incision and drainage is the primary treatment for cutaneous abscesses, including those in the genital area. For patients with a suspected anorectal abscess, a focused medical history and complete physical examination, including a digital rectal examination, are recommended 1.
Key Considerations
- Antibiotic therapy is recommended for abscesses associated with severe or extensive disease, rapid progression, signs and symptoms of systemic illness, associated comorbidities or immunosuppression, extremes of age, or abscess in an area difficult to drain 1.
- For empirical coverage of CA-MRSA in outpatients with SSTI, oral antibiotic options include clindamycin, TMP-SMX, a tetracycline, and linezolid 1.
- Patients should seek immediate care for fever, increasing pain, or difficulty urinating.
- Cowper's glands are bulbourethral glands that produce pre-ejaculatory fluid, and infections or blockages can lead to cyst or abscess formation.
- Warm compresses can help relieve discomfort while awaiting treatment.
Treatment Approach
- Treatment typically involves antibiotics for infection (such as ciprofloxacin 500mg twice daily for 7-14 days) and drainage of the abscess if present.
- For a simple cyst without infection, observation may be appropriate.
- Pain management with NSAIDs like ibuprofen 400-600mg every 6-8 hours is also recommended.
- After resolution, follow-up is important to ensure complete healing and to prevent recurrence, which may require surgical intervention in some cases.
Additional Considerations
- The use of rifampin as a single agent or as adjunctive therapy for the treatment of SSTI is not recommended 1.
- For hospitalized patients with complicated SSTI, empirical therapy for MRSA should be considered pending culture data, with options including IV vancomycin, linezolid, daptomycin, telavancin, and clindamycin 1.
From the Research
Cowper's Gland Abscess or Cyst
- An abscess of the Cowper's gland is a rare but severe clinical event that requires aggressive therapy and close follow-up due to its potentially high rate of early and late clinical complications 2.
- A case study reported a 63-year-old patient with a Cowper's gland abscess that spread to adjacent organs and tissues, leading to septic shock 3.
- Another case study reported a 64-year-old man with a recurrent Cowper's gland abscess that required surgical asportation of the gland 2.
- Cowper's gland syringoceles are rare cystic dilations of the Cowper's gland duct and can be diagnosed in childhood or adulthood 4.
- The function of the Cowper's gland secretions is to neutralize traces of acidic urine in the urethra, and knowledge regarding the various lesions and associated complications of this gland is scarce 5.
Anatomy and Secretion Mechanism
- The Cowper's gland involves not only smooth muscle but also the striated muscles of the pelvic floor, and its secretion and emission require the cooperation of these muscles 6.
- The gland is surrounded laterally and posterosuperiorly by striated and smooth muscles, respectively, and the smooth muscle is part of the deep transverse perineal muscle 6.
Clinical Complications
- Untimely treatment of a Cowper's gland abscess can lead to serious complications, including the spread of a purulent process to neighboring organs and tissues, and the development of septic shock 3.
- Recurrent Cowper's gland abscess may require surgical asportation of the gland 2.
- Cowper's gland syringoceles can be associated with scrotal abscess and require surgical excision 4.