Inflammation of Kupffer’s glands (bulbo-urethral glands) is called cuperitis. It can be unilateral or bilateral and is a common complication of urethral infections. It is possible to be confused clinically with prostatitis due to similarity and localization of symptoms. Cuperitis usually appears 2-3 weeks after acute urethritis. It can also occur after transurethral diagnostic and treatment procedures, in which the glands are infected retrogradely. The ducts of the gland are very small in caliber and quickly become clogged. Thus, the infection persists and spreads locally, inside the gland. The most common etiological cause of cuperitis are the same microorganisms that cause urogenital infections – E.coli, N. gonorrhea, Chlamydia trachomatis, Pseudomonas aeruginosa. Clinically, there are two forms of the course of the disease – acute and chronic cuperitis. Acute cuperitis develops quickly and begins with fever up to 40 ?�. Patients report severe pain and heaviness in the perineum, general malaise, frequent and painful defecation. Urination is also painful, difficult and slow, and sometimes complete retention of urine can occur due to inability to urinate. In these cases, it can easily be mistaken for a urethral stricture. Rapid blockage of the ducts of the gland leads to abscessation. The gland swells, becomes dense and fills with pus, and edema of the surrounding tissues develops. As a result, fistulization of the abscess cavity to the perineal skin, the urethra occurs, or in the most severe cases, the infection may proceed with the picture of a generalized infection – sepsis. When an abscess develops in Kupffer’s glands, patients complain of pain when walking, standing, sitting. Chronic cuperitis develops after acute cuperitis, but is usually associated with a defect in the jugular gland known as a syringocele. The latter literally means a cystically dilated duct of the Kupffer gland. Symptoms vary from asymptomatic flow to complete retention of urine with obstruction of the tubule and swelling of the cystic formation in the lumen of the urethra. Stasis of the secretion of the gland, caused by formed calcifications, is found in older patients. The diagnosis is made through a physical examination, laboratory and instrumental tests. In acute cuperitis, high sensitivity, severe soreness is found on the site of the affected gland (more often the left). Because the gland empties spontaneously, it may not be palpable. Instrumentally, echography is used as a method for ultrasound differentiation between acute and chronic cuperitis based on some echographic parameters – echogenicity, degree of vascularization of the parenchyma, resistance index. During the acute period of the disease, leukocytosis is observed in the laboratory, and leukocyturia in the urine. The causative agent can also be isolated by culture. The syringocele of the Kupffer gland can be visualized in the form of a canal,parallel to the urethra and must be differentiated from fistula, contrast material extravasation, or urethral duplication. The treatment is determined by the severity of the symptoms, the isolated causative agent and the clinical picture. Bed rest is recommended in combination with the administration of broad-spectrum antibiotics. Physiotherapy with warm procedures in the perineum area is also applied. In case of complete retention of urine, suprapubic drainage of the bladder is performed. When an abscess is formed, direct aspiration is applied as the most effective treatment procedure. In the treatment of the chronic form of cuperitis, transurethral opening of the syringocele to the lumen of the urethra is most often performed (marsupialization). But in certain cases, an incision and resection of the gland and possibly a perineal syringocele are required. References: Urology emergency – Prof. Dr. C. Slavov, MD.