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Rahoui M, Ouanes Y, Chaker K, Bibi M, Mrad Dali K, Sellami A, Ben Rhouma S, Nouira Y. An unusual cause of painful ejaculation in a young patient: Zinner syndrome. Ann Med Surg (Lond) 2022; 79:103982. [PMID: 35860150 PMCID: PMC9289330 DOI: 10.1016/j.amsu.2022.103982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction and importance: Zinner syndrome is a rare congenital malformation of the seminal vesicles and the homolateral upper urinary tract. While the majority of patients remain asymptomatic and are discovered incidentally, others present symptoms such as micturition or ejaculatory difficulties, or pain. We report a case of Zinner syndrome in a 32-year-old patient with painful ejaculation and discuss the diagnosis and treatment difficulties. Case presentation A 32-year-old married patient was consulted for pelvic pain associated with painful ejaculation that had been evolving for six months. The clinical examination was normal. Routine laboratory studies of blood and urine were normal. The patient was explored by ultrasound which showed the absence of the right kidney and the presence of a 7 cm right lateral prostatic cystic mass. On MRI, the right kidney was not visualized. Multiple cysts were seen in the right seminal vesicle. Surgical excision of the cyst by laparotomy was performed. The patient had an uneventful recovery and was discharged on the third postoperative day. Clinical discussion Congenital malformations of the seminal vesicles are often associated with those of the ipsilateral upper urinary tract, as the ureteral and seminal vesicle buds originate from the mesonephric duct. The syndrome often occurs in the second and third decades of life, especially after the onset of sexual activity. The most common symptoms were dysuria, perineal pain, epididymitis, and painful ejaculation. Diagnostic modalities include ultrasound, MRI, and cystoscopy. In patients with symptoms, the therapeutic management of the cyst includes ultrasound-guided aspiration and laparoscopic or open surgical excision. Conclusion Seminal vesicle cysts associated with homolateral renal agenesis or hypoplasia are a rare urologic anomaly. The treatment depends on the patient's symptoms. surgical excision of seminal vesicle cysts may be needed for large cysts causing obstructive symptoms. Zinner syndrome is a rare congenital malformation of the seminal vesicles and the homolateral upper urinary tract. The most common symptoms were dysuria, perineal pain, epididymitis, and painful ejaculation. Diagnostic modalities include ultrasound, MRI, and cystoscopy. Surgical excision of seminal vesicle cysts may be needed for large cysts causing obstructive symptoms.
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Grund C, Krieg VM, Leißner J. [And there was Zinner's syndrome-a rare differential diagnosis]. Urologe A 2022; 61:1243-1248. [PMID: 35420318 DOI: 10.1007/s00120-022-01828-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 10/18/2022]
Abstract
Zinner's syndrome is a rare congenital abnormality of the Wolffian ducts in male patients. It consists of the triad of renal agenesis, ipsilateral seminal vesicle dilatation, and obstruction of the ejaculatory duct. Symptoms often occur after puberty and can include hematospermia, painful ejaculation, dysuria, and local discomfort. We present the case of a 15-year-old patient with this rare condition who was treated surgically after the diagnosis was confirmed.
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Affiliation(s)
- Christina Grund
- Urologgia, Urologie im Helios Haus, Venloer Str. 389, 50825, Köln, Deutschland.
| | - Victoria Margaux Krieg
- Urologische Klinik, Kliniken der Stadt Köln gGmbH, Neufelder Str. 32, 51067, Köln, Deutschland
| | - Joachim Leißner
- Urologische Klinik, Kliniken der Stadt Köln gGmbH, Neufelder Str. 32, 51067, Köln, Deutschland
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3
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Zinner Syndrome-A Rare Cause of Recurrent Epididymitis and Infertility. Clin Pract 2021; 11:942-946. [PMID: 34940007 PMCID: PMC8700548 DOI: 10.3390/clinpract11040108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/03/2021] [Accepted: 12/07/2021] [Indexed: 11/17/2022] Open
Abstract
Zinner syndrome (ZS) is a rare disorder that affects only men. It is characterized by a triad of abnormalities, including unilateral renal agenesis, ipsilateral seminal vesicle cysts, and atresia of the ejaculatory tract. Unfortunately, there is no consensus on the best treatment modality. We describe a case of a young male patient with recurrent epididymitis, dysuria, and frequent urination. In the diagnostic evaluation, we found an extended right seminal vesicle in the ultrasound with hyperechoic fluid inside and an absence of the right kidney. We performed magnetic resonance imaging, computed tomography, and semen analysis confirming Zinner syndrome and deteriorated semen parameters. Urethroscopic evaluation and ultrasound-guided puncture of the seminal vesicle were performed. An abscess was excluded. The cytologic evaluation showed hemosiderophages. Tamsulosin was introduced. We found no signs of relapse in a six-month observation, and the patient had no further symptoms. Therefore, minimally invasive treatment is a feasible option in young patients found with early-stage Zinner syndrome.
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Almofareh AM, Aljuaid KM, Almirabi SA, Hakami YM, Alwan AM. Zinner Syndrome: A Case Report of a Rare Etiology of Infertility. Cureus 2021; 13:e17386. [PMID: 34584796 PMCID: PMC8457259 DOI: 10.7759/cureus.17386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2021] [Indexed: 11/05/2022] Open
Abstract
Infertility is a common medical issue with different etiologies. It can be related to female factors, male factors, or factors related to both partners. We report the case of a 35-year-old male patient who presented with primary infertility for 10 years. He was otherwise healthy with unremarkable past medical history. Physical examination revealed normal external genitalia with both testes were normal in size. Basic semen analysis revealed decreased sperm volume and sperm count. Abdominal ultrasound examination revealed an absent right kidney. Subsequently, the patient under a computed tomography scan that confirmed the right renal agenesis and demonstrated a well-defined right seminal vesicle cyst. Such findings were consistent with the diagnosis of Zinner syndrome. He underwent aspiration of the cyst that resulted in improvement in the sperm parameter of basic semen analysis. The case demonstrated a rare etiology of male infertility that was successfully managed conservatively. Despite its rarity, physicians should consider the developmental anomalies of the genitourinary system when encountering patients with infertility.
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Affiliation(s)
| | | | - Sewar A Almirabi
- Urology, Ibn Sina National College for Medical Studies, Jeddah, SAU
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Foladi N, Nasery MN. Right-sided Zinner syndrome with a left side quadrupled ureter- a case report. Radiol Case Rep 2021; 16:2873-2877. [PMID: 34401016 PMCID: PMC8349916 DOI: 10.1016/j.radcr.2021.06.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 06/27/2021] [Accepted: 06/29/2021] [Indexed: 11/11/2022] Open
Abstract
Zinner syndrome is a rare congenital anomaly of the genitourinary tract, consisting of ipsilateral renal agenesis, seminal vesicle cysts, and ejaculatory duct obstruction. Besides, quadruplication of the ureter is the rarest anomaly composed of proximal four ureters ending with a single distal ureter. The authors present an adult male patient with left flank pain and dysuria who was referred for abdomen CT scan. The CT scan revealed renal agenesis, seminal vesicle cysts, and obstructed ejaculatory duct, all in the right side (Zinner syndrome), and quadruplication of the ureter on the left side. The additional finding of hemivertebra was present resulting in kyphoscoliosis. Zinner syndrome and quadrupled ureter, are both rare anomalies, and the occurrence of both entities at the same patient is exceptionally rare, and have not been reported yet in the English literature. Furthermore, standard treatment protocols have to be pursued, as such patients hold a single kidney with the quadrupled ureter.
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Affiliation(s)
- Naqibullah Foladi
- Radiology department, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan
| | - Mohammad Nawaz Nasery
- Radiology Department, Kabul University of Medical Sciences (KUMS), Kabul, Afghanistan
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6
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Abakar D, Badi FE, Sabiri M, El Manjra S, Lezar S, Essodegui F. Zinner Syndrome. Eur J Case Rep Intern Med 2021; 8:002628. [PMID: 34268266 PMCID: PMC8276935 DOI: 10.12890/2021_002628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 05/12/2021] [Indexed: 11/05/2022] Open
Abstract
Zinner syndrome is a developmental anomaly of the urogenital tract. This condition is defined by the triad of unilateral renal agenesis, ipsilateral seminal vesicle cyst and ipsilateral ejaculatory duct obstruction. The syndrome is due to malformation of the mesonephric duct during embryogenesis. The condition used to be rare but is now frequently encountered due to the advent of MRI and CT. MRI confirms the diagnosis by revealing the seminal vesicle cyst and its contents, and the ejaculatory duct obstruction, while CT confirms renal agenesis. We report the case of a young patient with Zinner syndrome. LEARNING POINTS Zinner syndrome consists of the triad of renal agenesis, seminal vesicle cyst and ejaculatory duct obstruction.Any insult during embryogenesis of the mesonephric duct in men can result in Zinner syndrome.Pelvic MRI is the gold standard to confirm the diagnosis of Zinner syndrome.
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Affiliation(s)
- Djidda Abakar
- Central Radiology Service, IBN Rochd University Hospital, Casablanca, Morocco
| | | | - Mouna Sabiri
- Central Radiology Service, IBN Rochd University Hospital, Casablanca, Morocco
| | - Samia El Manjra
- Central Radiology Service, IBN Rochd University Hospital, Casablanca, Morocco
| | - Samira Lezar
- Central Radiology Service, IBN Rochd University Hospital, Casablanca, Morocco
| | - Fatiha Essodegui
- Central Radiology Service, IBN Rochd University Hospital, Casablanca, Morocco
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Córdoba Quishpe GA, Sierra Santos L, Maqueda Zamora G, García Morales A. Síndrome de Zinner: monorrenos especiales. REVISTA CLÍNICA DE MEDICINA DE FAMILIA 2021. [DOI: 10.55783/rcmf.140211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Presentamos el caso de un paciente de 13 años, monorreno de nacimiento, asintomático, sin otros antecedentes personales de interés, al que, durante un examen rutinario de su patología de base, se le realiza ecografía abdominal en la que se visualiza un probable quiste ureteral con una dilatación de la vesícula seminal compatible con un probable síndrome de Zinner.
Palabras clave: vesículas seminales, agenesia renal unilateral, anomalías congénitas.
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Affiliation(s)
- Golda Alexandra Córdoba Quishpe
- Residente de tercer año de Medicina Familiar y Comunitaria. Centro de Salud Mar Báltico. Hospital Universitario Ramón y Cajal. Madrid (España)
| | - Lucía Sierra Santos
- Especialista en Medicina Familiar y Comunitaria. Consultorio El Boalo. Madrid (España)
| | - Gloria Maqueda Zamora
- Residente de segundo año de Medicina Familiar y Comunitaria. Consultorio El Boalo. Hospital Universitario La Paz. Madrid (España)
| | - Antonio García Morales
- Residente de tercer año de Medicina Familiar y Comunitaria. Centro de Salud Barajas. Hospital Universitario Ramón y Cajal. Madrid (España)
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Ko A, Park SB, Park HJ, Lee ES. Zinner Syndrome with Ectopic Ureter Remnant. Curr Med Imaging 2021; 18:78-81. [PMID: 34102980 DOI: 10.2174/1573405617666210608151618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/21/2021] [Accepted: 03/12/2021] [Indexed: 11/22/2022]
Abstract
Zinner syndrome is a rare congenital abnormality defined by a clinical triad of unilateral renal agenesis, ipsilateral seminal vesicle cyst, and ipsilateral ejaculatory duct obstruction. Most patients are asymptomatic, but if the cystic dilatation of the seminal vesicle becomes significant, it can result in urinary symptoms such as dysuria and urinary retention. This rare developmental anomaly related to the mesonephric duct can also present with other abnormalities. Here, we report our experience of Zinner syndrome with bladder outlet obstruction and an ectopic ureter remnant.
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Affiliation(s)
- Ara Ko
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sung Bin Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun Jeong Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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Ying T, Degheili JA, Guerra L. A Newborn with Retrovesical Cysts and an Ipsilateral Multicystic Dysplastic Kidney. Urology 2021; 157:42-43. [PMID: 33819516 DOI: 10.1016/j.urology.2021.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 11/28/2022]
Abstract
We present a clinical imaging question focusing on a newborn with known prenatal history of a multicystic dysplastic kidney, and an incidental ipsilateral retrovesical seminal vesical cysts, raising the diagnosis of a Zinner Syndrome. The diagnosis is challenging in this age group. Surgical management is generally proposed for symptomatic cases at older age.
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Affiliation(s)
- Thomas Ying
- Division of Pediatric Urology, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, K1H 8L1, ON, Canada.
| | - Jad A Degheili
- Division of Pediatric Urology, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, K1H 8L1, ON, Canada.
| | - Luis Guerra
- Division of Pediatric Urology, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, K1H 8L1, ON, Canada.
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Cito G, Gemma L, Giachini C, Micelli E, Cocci A, Fucci R, Picone R, Sforza S, Nesi G, Santi R, Minervini A, Masieri L, Carini M, Coccia ME, Natali A. Sperm retrieval by conventional testicular sperm extraction for assisted reproduction in patients with Zinner syndrome. Clin Exp Reprod Med 2021; 48:85-90. [PMID: 33486943 PMCID: PMC7943355 DOI: 10.5653/cerm.2020.03769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 09/08/2020] [Indexed: 11/18/2022] Open
Abstract
We present data from three Caucasian men with Zinner syndrome who attended our center for the treatment of primary couple’s infertility. Each patient was scheduled for conventional testicular sperm extraction (cTESE) and cryopreservation. Sperm analysis confirmed absolute azoospermia. Patient 1 had right and left testis volumes of 24 mL and 23 mL, respectively; left seminal vesicle (SV) agenesis, severe right SV hypotrophy with right renal agenesis. Follicle-stimulating hormone (FSH) was 3.2 IU/L. Patient 2 exhibited right and left testis volumes of 18 mL and 16 mL, respectively; a left SV cyst of 32 × 28 mm, ipsilateral kidney absence, and right SV agenesis. FSH was 2.8 IU/L. Patient 3 showed a testicular volume of 10 mL bilaterally, a 65 × 46 mm left SV cyst, right SV enlargement, and left kidney agenesis. FSH was 32.0 IU/L. Sperm retrieval was successful in all patients. Nevertheless, cTESE should be performed on the day of oocyte retrieval.
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Affiliation(s)
| | - Luca Gemma
- Department of Urology, Careggi Hospital, Florence, Italy
| | - Claudia Giachini
- Assisted Reproductive Technology Centre, Careggi Hospital, Florence, Italy
| | - Elisabetta Micelli
- Assisted Reproductive Technology Centre, Careggi Hospital, Florence, Italy
| | - Andrea Cocci
- Department of Urology, Careggi Hospital, Florence, Italy
| | - Rossella Fucci
- Assisted Reproductive Technology Centre, Careggi Hospital, Florence, Italy
| | - Rita Picone
- Assisted Reproductive Technology Centre, Careggi Hospital, Florence, Italy
| | - Simone Sforza
- Department of Urology, Careggi Hospital, Florence, Italy
| | - Gabriella Nesi
- Pathology Section, Department of Health Sciences, University of Florence, Florence, Italy
| | - Raffaella Santi
- Pathology Section, Department of Health Sciences, University of Florence, Florence, Italy
| | | | | | - Marco Carini
- Department of Urology, Careggi Hospital, Florence, Italy
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Soliman AA, Alshukami AA, AlZuber WH. Zinner’s syndrome, radiological diagnosis for a rare syndrome with non-specific clinical presentation: case report. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00336-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Zinner’s syndrome is a rare congenital malformation involving the seminal vesicle that mostly shows cystic transformation. Embryogenesis of the kidney, ureter, seminal vesicle, and vas deferens can be altered if an insult occurs during the first trimester mainly between the 4th and the 13th gestational week. Cystic lesions of the seminal vesicle may present with a mass effect. Associated ipsilateral renal agenesis is a characteristic feature in more than 50% of patients as the seminal vesicles and ureteral buds originate from the mesonephric (Wolffian) duct. For management, the transrectal ultrasound provides good visualization of the seminal vesicles and the rest of the pelvic structures providing a good guidance for aspiration of the cysts.
Case presentation
We present a case of a seminal vesicle fluid-filled tubular lesion. The patient first complained of vague abdominal pain with lower abdominal fullness. He was clinically evaluated, and radiological evaluation was performed using different modalities, and finally, the patient took his decision to live with it without any intervention at present.
Conclusions
The combination of seminal vesicle cysts and ipsilateral renal agenesis, is a rare urological anomaly with an insult during the 1st trimester is to be considered as the first suspicion. Usual manifestations are caused by the seminal vesicle cysts that cause mass effect and irritation to the surroundings in the form of urinary bladder irritation and in sometimes obstruction as well as pain/discomfort in the perineum and scrotum. Epididymitis is frequently occurring as a complication. Treatment mainly consists of removing the seminal vesicle cyst/tubular lesion.
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Tuncer K, Kilinc G, Sert I, Akpinar G, Tugmen C. Ectopic ureter associated with Zinner's syndrome in a kidney recipient: case report and literature review. ACTA ACUST UNITED AC 2020; 66:692-695. [PMID: 32638967 DOI: 10.1590/1806-9282.66.5.692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/03/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Zinner's Syndrome is a triad of mesonephric duct anomalies comprising unilateral renal agenesis, seminal vesicle cyst, and ejaculatory duct obstruction. In this study, we present a kidney recipient with ectopic ureter associated with Zinner's syndrome and a literature review. CASE PRESENTATION A 59-year-old male with a history of chronic kidney disease and left renal agenesis underwent deceased donor kidney transplantation. After securing optimal renal functions, the patient underwent abdominal computed tomography (CT) scan for the seroma that occurred under the incision. The final diagnosis was an ectopic distal ureter ending in the seminal vesicle cyst's wall and ipsilateral renal agenesis. The patient was discharged without any complications and the clinical follow up was uneventful. DISCUSSION AND CONCLUSION Congenital seminal vesicle disorders are usually associated with ipsilateral urinary duct anomalies stemming from the same embryonic structure. To our knowledge, this is the first case report that describes kidney transplantation in a patient with ipsilateral renal agenesis and ectopic ureter ending in the seminal vesicle cyst. In patients with renal agenesis, during the ipsilateral urinary tract anastomosis, the possibility of ectopic ureter should be kept in mind otherwise graft loss can occur with a high morbidity rate.
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Affiliation(s)
- Korhan Tuncer
- Department of General Surgery, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Gizem Kilinc
- Department of General Surgery, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ismail Sert
- Department of General Surgery, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Goksever Akpinar
- Department of General Surgery, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Cem Tugmen
- Department of General Surgery, Tepecik Training and Research Hospital, Izmir, Turkey
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Demaeyer L, Holz S, Pamart D, Taylor S, Naudin M. Robotic management of painful Zinner syndrome, case report and review of literature. Int J Surg Case Rep 2020; 73:61-64. [PMID: 32634620 PMCID: PMC7338681 DOI: 10.1016/j.ijscr.2020.06.078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Zinner Syndrome is a congenital pathology due to an embryologic anomaly occurring between the 4th and 13th gestational week. This embryologic defect leads to unilateral renal agenesis, ipsilateral seminal vesicle cyst and ejaculatory duct obstruction. Most of the time patients are asymptomatic and do not need any treatment but for symptomatic cases, only surgical removal of the cyst and seminal vesicle are 100% effective. CASE The case presented here is that of a healthy 33-year old man with symptomatic right seminal vesicle cyst and ipsilateral renal agenesis. First a conservative approach was attempted but each time the symptoms ended up reappearing. We decided to use robot-assisted laparoscopy to completely resect the cyst and the right seminal vesicle. There was no postoperative complication and the patient's symptoms improved immediately. After a 6 months follow-up the patient remains completely asymptomatic. CONCLUSION Complete excision of the seminal vesicle cyst is the only 100% effective treatment option for symptomatic patients with Zinner syndrome. Minimally invasive approaches like conventional laparoscopy or robotic assisted laparoscopy are safe and effective and should currently be considered as the surgical gold standard.
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Affiliation(s)
- Laura Demaeyer
- Department of Urology, CHU Ambroise Paré, Mons, Belgium.
| | - Serge Holz
- Department of Urology, CHU Ambroise Paré, Mons, Belgium
| | - Didier Pamart
- Department of Urology, CHU Ambroise Paré, Mons, Belgium
| | - Steven Taylor
- Department of Radiology, CHU Ambroise Paré, Mons, Belgium
| | - Michel Naudin
- Department of Urology, CHU Ambroise Paré, Mons, Belgium.
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Hergan B, Fellner FA, Akbari K. Incidental imaging findings suggesting Zinner syndrome in a young patient with pulmonary embolism: A case report. Radiol Case Rep 2020; 15:437-441. [PMID: 32148603 PMCID: PMC7033301 DOI: 10.1016/j.radcr.2020.01.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/14/2020] [Accepted: 01/20/2020] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Benedikt Hergan
- Central Radiology Institute, Kepler University Hospital, Medical Faculty of the Johannes Kepler University, Krankenhausstrasse 9, Linz, Austria
| | - Franz A Fellner
- Central Radiology Institute, Kepler University Hospital, Medical Faculty of the Johannes Kepler University, Krankenhausstrasse 9, Linz, Austria.,Medical Faculty of the Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Kaveh Akbari
- Central Radiology Institute, Kepler University Hospital, Medical Faculty of the Johannes Kepler University, Krankenhausstrasse 9, Linz, Austria
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15
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Zinner’s Syndrome – The Value of Clinical Imaging and Morphopathological Findings for Diagnosis. JOURNAL OF INTERDISCIPLINARY MEDICINE 2019. [DOI: 10.2478/jim-2019-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Introduction: Cystic congenital malformations of the seminal vesicle are unusual. More than half of them are associated with ipsilateral renal agenesis. This disease was first described by Zinner in 1914, and since then, more than 200 cases have been reported. Most of the patients with this congenital disease present few symptoms until the middle-age.
Case presentation: A 61-year-old male was referred to the Urology Clinic with intermittent pain and sensibility in his lower left abdomen in the last 12 months accompanied by intermittent bowel obstruction. The digital rectal examination could not assess the prostate due to a rectal stenosis. On computed tomography and magnetic resonance imaging (MRI) a cystic tumor with close relations with the bladder wall and prostate, associated with left kidney agenesis was identified. The cystic tumor was surgically removed. The histopathological examination of the tumor revealed a multilocular seminal vesicle cyst, with a muscular wall.
Conclusions: Seminal vesicle cysts combined with ipsilateral renal agenesis are rare urological anomalies. Imaging allows a comprehensive investigation of renal and seminal vesicle anomalies. MRI seems to better visualize cysts and differentiate them from ureteroceles, while the histopathological examination contributes to a correct diagnosis. A multidisciplinary team (urologists, radiologists, and morphologists) is necessary for the proper diagnosis of Zinner’s syndrome.
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Tan Z, Li B, Zhang L, Han P, Huang H, Taylor A, Li X. Classifying seminal vesicle cysts in the diagnosis and treatment of Zinner syndrome: A report of six cases and review of available literature. Andrologia 2019; 52:e13397. [PMID: 31729082 DOI: 10.1111/and.13397] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/30/2019] [Accepted: 07/15/2019] [Indexed: 01/21/2023] Open
Affiliation(s)
- Zhengwu Tan
- Department of Radiology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Bing Li
- Department of Urology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Lan Zhang
- Department of Radiology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Ping Han
- Department of Radiology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Haitao Huang
- Department of Radiology University of Minnesota Minneapolis Minnesota
| | - Andrew Taylor
- Department of Radiology University of Minnesota Minneapolis Minnesota
| | - Xin Li
- Department of Radiology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
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Cito G, Sforza S, Gemma L, Cocci A, Di Maida F, Dabizzi S, Natali A, Minervini A, Carini M, Masieri L. Infertility case presentation in Zinner syndrome: Can a long-lasting seminal tract obstruction cause secretory testicular injury? Andrologia 2019; 51:e13436. [PMID: 31589772 DOI: 10.1111/and.13436] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/13/2019] [Accepted: 08/29/2019] [Indexed: 11/29/2022] Open
Abstract
Zinner syndrome (ZS) could represent an uncommon cause of male infertility, as result of the ejaculatory duct block, which typically leads to low seminal volume and azoospermia. A 27-year-old Caucasian man reported persistent events of scrotal-perineal pain and dysuria during the past 6 months. The andrological examination showed testicular volume of 10 ml bilaterally. Follicle-stimulating hormone was 32.0 IU/L, luteinising hormone was 16.3 IU/L, total testosterone was 9.0 nmol/L, and 17-beta-oestradiol was 0.12 nmol/L. The semen analysis revealed absolute azoospermia, semen volume of 0.6 ml and semen pH of 7.6. The abdominal contrast-enhanced computed tomography showed (a) left kidney agenesis; (b) an ovaliform hypodense mass of 65 × 46 millimetres with fluid content, which was shaping the bladder and the left paramedian prostatic region, compatible with a left seminal vesicle pseudocyst; and (c) an enlargement of the right seminal vesicle. The patient was diagnosed with ZS, and he was scheduled for robot-assisted laparoscopic left vesiculectomy. Subsequently, testis biopsy was characterised by complete germ cell aplasia. The onset symptomatology is often blurred and difficult to detect. It is important to diagnose and manage early this condition, because a long-lasting seminal tract obstruction could determine an irreversible secretory testicular injury.
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Affiliation(s)
- Gianmartin Cito
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Simone Sforza
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Luca Gemma
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Cocci
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Fabrizio Di Maida
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Sara Dabizzi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, Careggi Hospital, University of Florence, Florence, Italy
| | - Alessandro Natali
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Marco Carini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Lorenzo Masieri
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
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The Association of Renal Agenesis and Ipsilateral Seminal Vesicle Cyst: Zinner Syndrome Case Report. Case Rep Urol 2019; 2019:1242149. [PMID: 31341696 PMCID: PMC6612404 DOI: 10.1155/2019/1242149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/10/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction Zinner syndrome is a rare congenital malformation characterized by the association of an ipsilateral renal agenesis, ipsilateral seminal vesicle cyst, and ipsilateral ejaculatory duct obstruction. This case is one of the first to be reported in the Kingdom of Saudi Arabia. Case Presentation A 20-year-old Saudi male patient presented complaining of chronic left groin pain radiating to the left testis and the medial aspect of the left thigh for the last 6 years. Patient is also complaining of painful ejaculation with no history of lower urinary tract symptoms, hematuria, or trauma. Physical examination was unremarkable. Ultrasound (US) report from the referring hospital mentioned that there is a left pelvic mass. Computed tomography (CT) and magnetic resonance imaging (MRI) showed diffuse distension of left seminal vesicle (9 X 7 cm) cyst with ipsilateral left renal agenesis which corresponds to Zinner syndrome. Left seminal vesicle cyst excision through a low midline incision was done. The patient was asymptomatic during his follow-up in our clinic with disappearance of the pain. Conclusion The combination of a good clinical history and radiological assays aided in making the diagnosis. Surgical intervention is the mainstay in the management plan in symptomatic patients.
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Imaging findings of congenital anomalies of seminal vesicles. Pol J Radiol 2019; 84:e25-e31. [PMID: 31019591 PMCID: PMC6479056 DOI: 10.5114/pjr.2019.82711] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 11/02/2018] [Indexed: 11/30/2022] Open
Abstract
The seminal vesicles are paired organs of the male reproductive tract, which produce and secrete seminal fluid. Although congenital anomalies of seminal vesicles are usually asymptomatic, they may lead to various urogenital symptoms, including infertility. Due to their embryologic relationship with other urogenital organs, congenital anomalies of seminal vesicles may accompany other urinary or genital anomalies. Congenital anomalies of seminal vesicles include agenesis, hypoplasia, duplication, fusion, and cyst. These anomalies can be diagnosed with various imaging techniques. The main purpose of this article is to summarise imaging findings and clinical importance of congenital anomalies of seminal vesicles with images of some rare and previously unreported anomalies.
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