Congenital Seminal Vesicle Cyst Associated with Ipsilateral Renal Agenesis Mimicking Bladder Outlet Obstruction: A Case Report and Review of the Literature

Zinner Syndrome in Young Adult Males: A Case Series and Literature Review

Zinner syndrome (ZS) is a highly uncommon congenital or developmental urogenital anomaly characterized by the triumvirate of unilateral renal agenesis or dysplasia, ipsilateral ejaculatory duct obstruction, and ipsilateral seminal vesicle cyst. We present three cases of ZS in a 21-year-old male, a 20-year-old male, and a 24-year-old male. The diagnostic evaluation revealed unilateral renal agenesis associated with hypertrophy of the ipsilateral seminal vesicle with cystic changes on investigation by ultrasonography (USG), computed tomography (CT), and magnetic resonance imaging (MRI). The patients underwent surgical management, resulting in symptom resolution and enhanced quality of life. This case report highlights the diagnostic challenges, management options, and long-term outcomes for patients with ZS.

Zinner's syndrome: A rare diagnosis of congenital seminal vesicle cyst and renal agenesis on basis of radiological imaging and its management

INTRODUCTION AND IMPORTANCE

Seminal vesical cyst (SVC) together with ipsilateral renal agenesis known as Zinner's syndrome is a rare congenital malformation mostly asymptomatic and is detected in second to fourth decade of life presenting with symptoms of bowel and bladder neck irritation/obstruction. Diagnosis is based mainly on various imaging techniques with MRI being the confirmatory. Recent management includes laparoscopic excision of the SVC but conventional aspiration of the cystic fluid together with explorative open excision of the cyst is still regarded useful.

CASE PRESENTATION

A 32 years old male presented with urgency and frequency of micturition, constipation, post ejaculatory pain and USG, CT, MRI findings suggestive of right renal agenesis and bilateral seminal vesicle cyst.

CLINICAL DISCUSSION

As other studies show, our patient is a sexually active male with characteristic symptoms of bladder and bowel obstruction. USG, CT, MRI were used for diagnosis co-relating other studies. Intervention was done by aspiration of the cystic fluid and open surgical excision of the cyst.

CONCLUSION

Zinner's Syndrome is uncommon cause of symptoms of bowel and bladder obstruction in young men; whose diagnosis is mostly based on imaging techniques.

Robot-Assisted Laparoscopic Resection of the Mesonephric Duct Remnant in a Patient with Zinner Syndrome

Introduction: A 17-year-old male with Zinner syndrome, a right seminal vesicle cyst, and a solitary left kidney presented with chronic pelvic pain. Previous surgeons had attempted robot-assisted laparoscopic seminal vesicle cyst aspiration and transurethral resection of the ejaculatory duct. Neither surgery provided sustained symptom relief. Abdominal and pelvic MRI showed a cystic structure lodged between the prostate and bladder. The right seminal vesicle, kidney, and ureter were not observed. Materials and Methods: A robot-assisted laparoscopic seminal vesiculectomy was planned. Dissection distal to the right vas deferens and between the bladder neck and prostate revealed a cystic seminal vesicle-like structure. Attached to this was a tubular structure coursing deep to the vas deferens from the right renal fossa. This was presumed to be a dysplastic ureter. The dysplastic ureter was transected from the seminal vesicle and the seminal vesicle was marsupialized to the deep pelvis. Proximally, the dysplastic ureter was transected and left open. Results: Histologic assessment of the specimen revealed an ∼12.1 cm tubular mesonephric remnant. The postoperative course was uncomplicated. At 6 months follow-up, the patient remains free of symptoms with preserved ejaculatory volume. Conclusions: Mesonephric duct abnormalities and symptoms present on a spectrum. We present a safe and effective resection of a mesonephric duct remnant from a 17-year-old male with Zinner syndrome. A robotic approach localized to the right allowed for excellent observation without compromising left-sided genitourinary anatomy. In males presenting with renal agenesis and pelvic symptoms, clinicians should be suspicious of Zinner syndrome and other mesonephric abnormalities.

Incidental imaging findings suggesting Zinner syndrome in a young patient with pulmonary embolism: A case report

A triad of seminal vesical cyst, ipsilateral renal agenesis and ipsilateral ejaculatory duct obstruction is known as Zinner Syndrome. First described in 1914, only about 200 cases have been reported in literature. Usually it stays undiagnosed until the second to third decade of life due to lack of symptoms or nonspecific symptoms such as lower urinary tract symptoms, dysuria or painful ejaculation. In this report we present the case of a 22-year-old patient with a Zinner syndrome as an incidental finding and underlie a review of literature to show the main clinical and imaging implications.

Zinner syndrome: an unusual cause of bladder outflow obstruction

Zinner syndrome is a rare condition comprising a triad of unilateral renal agenesis, ipsilateral seminal vesicle obstruction and ipsilateral ejaculatory duct obstruction. The mutual embryological origins of the seminal vesicle and the ureteral bud result in both anomalous genital and urinary tracts. We present the case of a 39-year-old patient where the initial presentation of this condition was bladder outflow obstruction. In this paper, we discuss the embryological origin of this condition, the range of imaging tools used to diagnose Zinner syndrome and the inherent benefits and shortcomings of each modality.

Zinner syndrome diagnosed by magnetic resonance imaging and computed tomography: role of imaging to identify and evaluate the uncommon variation in development of the male genital tract

Seminal vesicle cysts are a very rare condition and its often associated with ipsilateral renal agenesis. The diagnosis of seminal vesicle cysts may be delayed or missed because of the non-specific symptoms of this condition. This article reports a triad of right renal agenesis, ipsilateral seminal vesicle cyst, and ejaculatory duct obstruction (Zinner syndrome) in a 56 years old man.

Congenital Seminal Vesicle Cyst and Ipsilateral Renal Agenesis (Zinner Syndrome): A Rare Association and Its Evolution from Early Childhood to Adolescence

Zinner syndrome, the association of congenital seminal vesicle cyst and ipsilateral renal agenesis, is more often reported in adults or older adolescents. We present a case of a boy, followed up in our hospital since birth for right renal agenesis who at the age of 4 years presented a right paravesical cyst on ultrasound. The cyst was initially considered as an ureterocele. The diagnosis of Zinner syndrome was made later, at the age of 15 years by ultrasound and magnetic resonance imaging; at that moment the cyst had increased in size and had changed in aspect. This malformation should be considered in the differential diagnosis of a pelvic cyst in male patients with renal agenesis.

[Ejaculatory system cysts: a case report]

INTRODUCTION

Male pelvic floor cysts are a rare clinical entity that include: Wolffian duct remnants, Müllerian duct remnants, cysts of the seminal vesicles, prostate and ejaculatory duct/vas deferens cysts.


CASE REPORT

We report the clinical case of a 21-year-old male patient with a history of previous surgery in childhood and more precisely: partial colectomy for congenital megacolon, removal of dysplastic right kidney and subsequent surgical adhesiolysis for bowel obstruction.
 At 17, the patient was submitted to MRI for groin pain with an incidental finding of a cystic mass at the level of the right seminal vesicle. Consequently, a TUR-ED was performed at another urology unit, for a suspected seminal vesicle ectasia, without resolution of pain symptoms. The patient was referred to us for persistent genitourinary infections, ejaculation disorder and episodes of gross hematuria. An additional MRI confirmed the presence of a cystic mass of 5,5 cm with a suspected opening into prostatic urethra. Urethrocystoscopy and urethrocystography retrograde confirmed this anatomical communication. For the persistence of the symptoms we performed retropubic surgical exeresis of the mass, with a histopathological finding of benign cyst of the vas deferens.
 Two major postoperative complications were reported: a pelvic hematoma that required surgical exploration and a urinary extravasation at the level of prostatic urethra, which resolved with prolonged urethral catheterization.


CONCLUSIONS

Male pelvic floor cysts are a rare disease with a complex clinical and therapeutic management. A correct diagnosis is based on clinical signs and symptoms together with imaging studies of the pelvic region. The high risk of erectile dysfunction and ejaculatory disorders correlated to a surgical approach, recommend a treatment of these lesions only for symptomatic cases.

Management of Zinner's Syndrome Associated with Contralateral Seminal Vesicle Hypoplasia: A Case Report

A 27-year-old man presented with chronic hematospermia, painful ejaculation, and primary infertility. Physical examination, transrectal ultrasonography, and pelvic magnetic resonance imaging (MRI) demonstrated left seminal vesicle cyst, left renal agenesia, and contralateral seminal vesicle hypoplasia. Hormone workup (LH, FSH, prolactin, and testosterone) was normal. Sperm analysis showed oligoasthenozoospermia and low ejaculate volume. We performed transurethral resection of the ejaculatory duct (TUR-ED) using methylene blue vasography guidance without surgical-related complications. Hematospermia and painful ejaculation completely improved at 2-month followup, and the patient's wife experienced a missed abortion thereafter. This patient was considered as a rare variant of Zinner's syndrome and was managed effectively with a less invasive treatment modality (TUR-ED).