Zinner's syndrome: an up-to-date review of the literature based on a clinical case

Zinner Syndrome: Case report of atypical symptoms and literature

Zinner Syndrome is a rare congenital anomaly of the urogenital tract, characterized by unilateral renal agenesis, ejaculatory duct obstruction and ipsilateral seminal vesicle cyst. Here, we present a case of a 54-year-old-male with anejaculation and frequent nocturnal emissions, denies fever, scrotal or perineal pain, hematospermia, hematuria, or lower urinary tract symptoms. Imaging studies revealed atypical findings of this syndrome. This study highlights the importance of recognizing atypical symptoms and appropriate management to relieve symptoms and improve quality of life.

Zinner syndrome: report of a case and whole exome sequencing

BACKGROUND

Zinner syndrome is a rare congenital malformation of the male genitourinary system, characterized by a triad: seminal vesicle cyst, unilateral renal agenesis, and ipsilateral ejaculatory duct obstruction. The etiology of this uncommon disease remains largely elusive; however, genetic mutations may contribute to its development. In this report, we present a case of symptomatic Zinner syndrome that was surgically treated, alongside an investigation into the potential genetic basis of the syndrome via whole exome sequencing.

CASE PRESENTATION

We report the case of an 18-year-old male presenting with urinary pain and was diagnosed with right renal agenesis and a left seminal vesicle cyst following comprehensive imaging. The patient also experienced perineal pain and urgency, without symptoms of frequent urination, dysuria, or hematuria, and no familial history of genitourinary anomalies was documented. He successfully underwent laparoscopic resection of a pelvic mass, with pathological examination confirming a seminal vesicle cyst. Postoperative recovery was uneventful. Whole exome sequencing of blood and tissue samples highlighted myeloma overexpressed gene (MYEOV), B melanoma antigen family member (BAGE), and N-acetylated-alpha-linked acidic dipeptidase 2 (NAALAD2) as potential mutated genes related to Zinner syndrome. Additionally, two predisposing genetic variants were identified.

CONCLUSIONS

Zinner syndrome is a rare condition commonly diagnosed via various imaging modalities. Surgical resection remains the most effective treatment for symptomatic cases. Gene sequencing provides valuable insights into the genetic etiology of Zinner syndrome, enhancing our understanding and potentially guiding future diagnostic approaches.

Surgical treatment of giant seminal vesicle cyst with ureteral compression: a case report

Background

Seminal vesicle cysts (SVCs) are rare benign diseases in men and are commonly asymptomatic. Giant SVCs with complications there are no standard treatments for SVCs, however surgical intervention is required for giant SVCs accompanied with complications.

Case summary

We present one case of a 49-year-old male patient diagnosed with giant SVC. Chief complaint of this patient was persistent gross hematuria for 1 week. Both a computed tomography (CT) and magnetic resonance imaging (MRI) scans indicated the presence of a cystic mass in left seminal vesicle with hemorrhage, of which the maximum diameter is 6.5 cm. Additionally, Giant SVC squeezed the prostate and lower ureter, leading to the dilatation of the left upper ureter and hydronephrosis. After a thorough preoperative evaluation, a laparoscopic resection of SVC and left ureteral stenting were performed. The subsequent pathological analysis identified a seminal vesicle cyst inflammatory infiltration. Postoperative follow-up indicated no abnormalities in left seminal vesicle.

Conclusion

Laparoscopic surgery is recommended for giant SVCs with complications.

Zinner syndrome in childhood and adolescence: Report of four cases and review of the literature

Zinner syndrome is a rare congenital malformation of the urinary system that occurs exclusively in males. It consists of renal agenesis, ipsilateral obstruction of the ejaculatory duct, and cystic changes in the seminal vesicles. It is rarely described in the pediatric population due to the absence of symptoms, as well as the failure to recognize it due to masking by other morphological changes and conditions. Four patients from the pediatric population are presented. Two patients were asymptomatic, and the changes were detected incidentally or during other diagnostic procedures. The other two patients exhibited symptoms and signs such as testicular pain, abdominal pain, hematuria, and hematospermia, along with megaureter. Ultrasound serves as the initial diagnostic method, while confirmation of Zinner's syndrome is established by MR urography. In cases that ultrasound verified kidney agenesis and ipsilateral anechoic, avascular tubulocystic structures, it is necessary to perform follow-up MR urography to confirm or exclude Zinner's syndrome. Following diagnosis, asymptomatic pediatric patients should be monitored every 6 months to a year, using ultrasound, with particular attention to cyst size and content.

A rare variant of zinner syndrome with ejaculatory duct cyst: case report and challenges in diagnosis and management

BACKGROUND

Zinner syndrome (ZS) is a congenital malformation characterized by a triad of mesonephric (Wolffian) duct dysplasia, first identified by Zinner in 1914. The classical presentation of ZS includes unilateral renal hypoplasia or dysplasia, ipsilateral seminal vesicle cysts, and obstruction of the ejaculatory duct. This case presents a rare variant of the syndrome, where an ejaculatory duct cyst is observed instead of the typical ipsilateral seminal vesicle cyst. The ejaculatory duct cyst affected the vas deferens bilaterally, leading to bilateral atrophy or erosion of the seminal vesicle glands, and resulted in the absence of seminal fluid, ultimately causing azoospermia and infertility.

CASE PRESENTATION

Prior to surgery, the patient experienced a sensation of incomplete defecation, accompanied by mild anal distension. Two semen analyses revealed azoospermia, and magnetic resonance imaging/magnetic resonance urography indicated the absence of the left renal component and suggested the presence of a seminal vesicle cyst. It was hypothesized that the azoospermia resulted from compression of the contralateral ejaculatory duct by the seminal vesicle cyst on the affected side. Consequently, a decision was made to proceed with laparoscopic resection.During the surgical procedure, no seminal vesicle cyst was identified; however, an ejaculatory duct cyst was discovered, wherein the bilateral vasa deferentia converged without any alternative outlet. The cyst was subsequently resected. Postoperatively, the patient's clinical symptoms resolved, although the issue of infertility remained unaddressed.

CONCLUSION

This case describes a rare Zinner syndrome variant where an ejaculatory duct cyst replaces the seminal vesicle cyst, leading to seminal vesicle atrophy, azoospermia, and infertility. An unreported variant was discovered during surgery, underscoring the importance of preoperative imaging. Laparoscopic removal alleviated symptoms but not infertility, indicating that assisted reproduction might be necessary for ZS-related azoospermia. This case expands knowledge of ZS variants and their impact on fertility.

Zinner syndrome: A rare congenital cause of infertility

Zinner syndrome is a rare congenital malformation characterized by cystic seminal vesicles and ejaculatory duct obstruction in association with ipsilateral renal agenesis. It appears to be frequently linked to infertility. However, recent advances in imaging, notably MRI, have led to an increase in the diagnosis of this pathology. We describe the case of a 39-year-old patient receiving examination for primary infertility who was identified with Zinner syndrome using ultrasound, CT, and MRI; the patient did not report hemospermia, lower urinary tract symptoms, or perineal pain. Examining the abdomen and external genitalia revealed no abnormalities, and examining the rectal area revealed none at all. Zinner syndrome is a rare congenital condition; we report this case to highlight the etiopathogenesis of this seminal anomaly, its relationship with renal dysgenesis, and to illustrate the imaging of this condition through various diagnostic methods.

Zinner syndrome: A mesonephric duct anomaly with renal agenesis, ipsilateral seminal vesicle cyst, and ejaculatory duct obstruction

Anomalies of the mesonephric duct are associated with a combination of renal agenesis/dysgenesis, ejaculatory duct obstruction, and seminal vesical cyst, called Zinner syndrome. We present a case of this rare syndrome in a young male patient, who initially presented with urinary symptoms. The relevant embryology and diagnostic modalities are discussed.

Pediatric Zinner syndrome variants: Case series with newer insights into pathogenesis in early childhood

INTRODUCTION

Zinner Syndrome (ZS) is a rare congenital disorder characterized by seminal vesicle cysts (SVC) and ipsilateral upper urinary tract abnormalities, mainly due to developmental anomalies of the mesonephric duct. This series highlights our institutional experience with pediatric ZS, with a review of the current literature offering insights into its etiopathogenesis in early childhood.

MATERIAL AND METHODS

A retrospective case review of pediatric ZS diagnosed at our institution from 2019 to 2023, alongside a comprehensive literature review.

RESULTS

Four pediatric ZS cases were identified, a neonate, an infant and two older (pre-pubertal) children, presenting with recurrent epididymo-orchitis and/or UTIs. The two older children had duplex systems, both undergoing curative upper moiety heminephrectomy; the infant underwent nephroureterectomy and the neonate is under observation, asymptomatic for past 18 months.

DISCUSSION

When Zinner identified the link between unilateral renal agenesis and ipsilateral SVC in 1914, the condition's embryological basis was attributed to incorrect ureteric bud migration from the mesonephric duct, failing to stimulate the metanephros, leading to renal agenesis/dysplasia and this disruption was hypothesized to obstruct seminal vesicle drainage, causing cyst formation. Another theory suggests anomalous development of the distal mesonephric duct leading to ejaculatory duct atresia/stenosis which results in cystic enlargement of the seminal vesicles which, in turn, leads to aberrant ureteral budding, resulting in renal malformations. It is our belief that the SVCs, that are typically problematic in adolescence/adulthood due to secretion accumulation, sometimes manifest in childhood due to urinary reflux into the seminal vesicles, leading to epididymo-orchitis or UTIs. This contrasts with adult pathogenesis, where ejaculatory duct obstruction predominates. Hence, treatment leans towards a conservative approach for asymptomatic cases, with surgery reserved for symptomatic children. The scope of this case series is limited by the rare nature of ZS in prepubertal children (41 published cases in English literature), preventing a comprehensive understanding of its untreated natural history and restricting the formulation of generalized recommendations.

CONCLUSION

The variability in presentation of ZS in children necessitates a tailored approach. Unlike adults, where ejaculatory duct obstruction is the common cause, pediatric ZS symptoms mainly stem from urethra-cystic reflux, leading to recurrent infections.

Zinner syndrome: a radiological journey through a little known condition

Zinner syndrome is a rare congenital urological entity, secondary to an alteration in embryogenesis between 4th and 13th weeks of gestation, specifically because of abnormalities in the development of the distal mesonephric duct. It is characterized by the triad of unilateral renal agenesis, cystic dilatation of the ipsilateral seminal vesicle and ipsilateral ejaculatory duct obstruction. The aim of this article is to provide the reader with all the necessary information to be able to suspect the presence of this syndrome, reviewing its physiopathology, clinical manifestations and the imaging techniques that enable its diagnosis, emphasizing those radiological findings by MRI that should lead us to think about it. This work is illustrated with representative radiological images of cases belonging to our institution, including patients with different variants of Zinner syndrome. We also include an overview of the embryology of the male urogenital system, to remember the role of the mesonephric duct and the ureteral bud in the formation of the different urogenital structures, as well as a differential diagnosis that allows us to differentiate seminal vesicle cysts from other pelvic cystic lesions.

Zinner syndrome in pediatric age group: An underdiagnosed entity

INTRODUCTION

Zinner Syndrome (ZS), a rare congenital malformation of the mesonephric duct, combines seminal vesicle cyst (SVC) with ipsilateral upper urinary tract abnormalities. Typically asymptomatic in childhood, ZS manifests between 2nd to 4th decades with bladder symptoms, perineal pain and infertility. Diagnostic confirmation with additional imaging is needed when either renal or seminal abnormalities are identified.

MATERIALS AND METHODS

A retrospective study spanning 22 years identified 20 pediatric ZS cases through clinical analytics. Demographic, clinical, and radiological data were analyzed, including presenting complaints, imaging modalities (ultrasound, CT, MRI), and surgical findings. The study was HIPAA-compliant and IRB-approved.

RESULTS

Among 20 cases (mean age: 7.3 years), clinical presentations included asymptomatic cases, urinary symptoms, and abdominal pain. Imaging revealed renal anomalies (agenesis, multicystic dysplastic kidney) and seminal vesicle abnormalities. Surgical interventions (n = 12) addressed symptomatic cases, often involving robotic or laparoscopic procedures.

DISCUSSION

ZS, though rare, presents with varied clinical features, necessitating a multidisciplinary approach. Early diagnosis is facilitated by prenatal identification of renal abnormalities. Surgical intervention is reserved for symptomatic cases, with techniques such as vesiculectomy and resection of remnant structures employed.

CONCLUSION

This study highlights ZS's diverse clinical and radiological spectrum, emphasizing the need for vigilance in detecting overlapping entities. Timely identification, utilizing advanced imaging techniques, is crucial for accurate diagnosis and appropriate management of Zinner Syndrome in the pediatric population.

Zinner Syndrome: The Diagnosis and Management of a Rare Urogenital Malformation

This case highlights an atypical but important consideration in young males presenting with persistent gastrointestinal and/or genitourinary symptoms. Zinner syndrome (ZS) develops from embryologic maldevelopment of the distal mesonephric duct, resulting in ejaculatory duct atresia with consequent obstruction of the seminal vesicle and concomitant ureteral bud malformation, leading to renal agenesis/dysplasia. The lack of distinct clinical symptoms makes ZS a difficult diagnosis to reach: Abdominal pain and dysuria are often mistaken for prostatitis or cystitis. However, the use of modern imaging modalities aids in establishing the diagnosis. Early identification of ZS may delay progression to infertility as the duct obstruction may not be as extensive, though further research is needed to establish this connection.

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.

Ectopic Ureter: Spectrum of Magnetic Resonance Imaging Findings

OBJECTIVE

This study aims to describe the MRI findings of six patients with ectopic ureters in a tertiary care institute.

METHODS

A retrospective analysis was conducted on six patients presenting to the Department of Radiodiagnosis at Sawai Man Singh (SMS) Hospital, Jaipur, India, with ectopic ureters. Data were collected from the 3 Tesla (3T) Philips MRI scanner (Koninklijke Philips N.V., Amsterdam, Netherlands) from 2021 to 2023.

RESULTS

The mean age was 21.6 years, with an equal male-to-female ratio (1:1). Most patients presented with urinary incontinence (50%, n = 3), followed by abdominal pain. Only 16.6% (n = 1) were associated with a duplex collecting system. In males, the most common site was the seminal vesicle, observed in 66.6% (n = 2), followed by the urethra in 33.4% (n = 1) of cases. One patient with an ectopic opening into the seminal vesicle had Zinner syndrome. In females, the ectopic site was found to be the vagina in all three patients.

CONCLUSION

Ectopic ureter is a rare anomaly of the urinary system, often associated with other urinary system anomalies and a few syndromes. Clinical presentations range from the patient being asymptomatic to renal failure; therefore, a high index of suspicion and appropriate imaging are necessary for early diagnosis and timely treatment.

A Rare Variant of Zinner Syndrome Involving Ectopic Ureteral Implantation into the Seminal Vesicle Causing Recurrent Epididymitis

Zinner syndrome is a rare congenital anomaly characterized by a triad of renal dysgenesis/agenesis, cysts in the ipsilateral seminal vesicle, and ejaculatory duct obstruction. Though often diagnosed in infancy, the diagnoses can be incidentally found in adults who present with nonspecific genitourinary symptoms including dysuria, ejaculatory dysfunction, or genital pain. We present an unusual case of a 29-year-old male patient who presented to the emergency department with recurrent testicular pain and hematospermia and was found to have an atrophic right kidney with an ectopic ureter implanting into a cystic seminal vesicle. These findings were consistent with a rare subvariant of Zinner syndrome only previously described four times in the literature. We performed a robotic-assisted laparoscopic ectopic nephroureterectomy with sparing of his seminal vesicle. To our knowledge, this is the first report to describe the safe and effective use of robotic surgery in this setting to remove affected anatomy while preserving the patient's seminal vesicle.

Zinner's syndrome: Masquerading as pyonephrotic ectopic kidney

Zinner's syndrome is a rare developmental anomaly of Wolffian duct, comprising a triad of seminal vesicle cyst, ipsilateral renal agenesis and ejaculatory duct obstruction, first described by Zinner in 1914. Several aberrations have been reported like renal dysplasia, ectopic ureteric orifice in one of the derivatives of Wolffian duct. Usually it presents in second to fourth decade of life with symptoms of urinary bladder irritation/obstruction, cyst distension, ejaculatory duct obstruction. The diagnosis is principally based on imaging studies, usually confirmed by MRI. Treatment is based upon the persistent symptoms or complications related to it. Excision of cyst is gold standard.

Zinner’s syndrome: Triad of seminal vesicle cyst, ejaculatory duct obstruction and ipsilateral renal agenesis: A rare case series

Zinner’s syndrome is a very rare congenital condition characterised by seminal vesicle cyst, obstruction of the ejaculatory duct and ipsilateral renal agenesis. Here, we present a 25-year- old young short-statured male presented with left lower abdominal colicky pain. MRI abdomen showed the absence of the left kidney with a seminal vesicle cyst on the left side. The cyst in question was laparoscopically de-roofed. A second case is a 16-years-old young male who presented with intermittent lower abdominal pain. MRI abdomen showed seminal vesicle cyst with ipsilateral absent kidney which is managed conservatively with medication.

Level of evidence: Not applicable

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.

Zinner syndrome: a rare diagnosis in infancy

We present a case of Zinner syndrome (ZS), where we were fortunate to diagnose a child with this rare syndrome immediately after birth. Gross hydronephrosis was observed during the prenatal period on ultrasound, and further imaging after birth confirmed the presence of a multicystic dysplastic kidney and seminal vesicle cyst. The majority of cases of ZS is asymptomatic; however, symptoms relating to urination, ejaculation or infertility may present later on in life and so regular follow-up is required to ensure interventions can be carried out if such symptoms do occur.

[And there was Zinner's syndrome-a rare differential diagnosis]

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.

Zinner Syndrome with Ectopic Ureter Remnant

INTRODUCTION

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.

CASE PRESENTATION

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 mesonephric duct can also present with other abnormalities.

CONCLUSION

Here, we report our experience of Zinner syndrome with bladder outlet obstruction and an ectopic ureter remnant.

A Triad of Unilateral Renal Dysgenesis with Ipsilateral Seminal Vesical and Ejaculatory Duct Obstruction: An Uncommon Urogenital Congenital Anomaly, Zinner Syndrome-A Case Report

Zinner syndrome is a rare congenital anomaly of the urogenital system resulting from an in utero insult during the first trimester. This entity comprises a triad of unilateral renal agenesis/dysgenesis with ipsilateral seminal vesical and ejaculatory duct obstruction. This combination of urinary and genital abnormalities occurs because of the closely related embryological origin of these structures from the distal mesonephric (Wolffian) duct. Nearly 200 cases of seminal vesical cysts with ipsilateral renal agenesis have been reported in the literature. The affected person generally presents in early adulthood when the reproductive activity commences. In this report, we present a case of a 22-year-old male with complaints of painful ejaculation.

Zinner's syndrome, a retrospective series of three cases: different strategies to the same problem

A 106 years have passed since Zinner's syndrome was first described and current knowledge is still almost exclusively based on case reports. This article presents three patients with Zinner's syndrome with different clinical presentations and consequent different treatment options, showing the possible full spectrum of this condition. The first patient presented with storage lower urinary tract symptoms and benefited from laparoscopic removal of the seminal vesicle. The second patient has an incidental diagnosis on CT and remains asymptomatic on follow-up. The third patient presented with persistent lumbar pain and underwent open surgical removal of the seminal vesicle. The authors further present a literature review of the current knowledge on this topic, hopefully to clarify the state of art and improve the management of these patients.

Zinner Syndrome: A Case Report of a Rare Etiology of Infertility

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.

Zinner's syndrome: Case report of a rare maldevelopment in the male genitourinary tract

Zinner syndrome is a rare congenital malformation of the urogenital tract. It is due anomaly in the developmental of Wolffian duct. Zinner syndrome comprises triad of seminal vesicle cyst, unilateral renal agenesis and ipsilateral ejaculatory duct obstruction. It is frequently associated with infertility. Herein we are highlighting a case of a 35 years-old male, a father of 4 biological children who presented to our clinic due to right hemiscrotal pain, associated with post ejaculation pain.

Zinner syndrome: two cases and review of the literature

Zinner syndrome (ZS) is a rare congenital malformation due to abnormal development of the urogenital tract. It is caused by a growth failure of the distal part of the Müllerian duct in early embryogenesis. It is characterised by the triad of unilateral renal agenesis, ipsilateral seminal vesicle cyst and ipsilateral ejaculatory duct obstruction. Over the years, several cases have been reported in the literature since the initial report by Zinner in 1914. This syndrome is frequently misdiagnosed because it may present different patterns and the symptoms may be not specific. In this paper, we present two patients with two different patterns of presentation of Zinner syndrome.

Robot-Assisted Laparoscopic Approach in a Patient of Zinner Syndrome with Hematuria: A Rare Presentation

Congenital malformations of the seminal vesicles (SVs) are rare and are often associated with abnormalities of the ipsilateral upper tracts as embryologically both the ureteral buds and SVs arise from the mesonephric ducts. The triad of SV cysts, ipsilateral renal agenesis, and ejaculatory duct obstruction is known as the Zinner syndrome. We herein present the case of Zinner syndrome with hematuria as the mode of presentation. A 52-year-old gentleman presented with complaints of gross and painless hematuria for 3 months. An initial ultrasound revealed absent right kidney with a cystic structure abutting the urinary bladder. Cystoscopic examination revealed a high bladder neck. Magnetic resonance imaging of the abdomen revealed an absent right kidney and a large tubular structure in the region of the right ureter extending up to right SV with blood content and stones within. It was distally seen communicating with one of the cysts of the right SV. The cystic structure was removed with a robot-assisted laparoscopic approach. The console time was 110 min with minimal blood loss. Postoperative course was uneventful. Histopathology of the cyst wall revealed chronic inflammation. The patient is doing well on 6 months follow-up. This case was unique in terms of it presenting with a large intra-abdominal cyst with sharp stones within, probably first of its kind to be ever reported. Surgery is mandated for such symptomatic cysts and the daVinci robot with its minimally invasive approach offers the perfect platform for treating such challenging cases.

Zinner Syndrome with Ectopic Ureter Emptying into Seminal Vesicle

A 66-year-old male patient in follow-up in the urology department for a non-muscle-invasive bladder cancer was detected by ultrasound to have absence of the left kidney and a cystic, multilobed image at the location of the seminal vesicle. Magnetic resonance imaging reveals left renal agenesis and the existence of multiple cysts in the ipsilateral seminal vesicle that reaches a size of 6.9 × 3.7 cm, as well as a ureteral remnant that opens into the seminal vesicle. The patient does not present urinary symptoms, neither pain with ejaculation nor hematuria. A triad of seminal vesicle cyst, ipsilateral renal agenesis, and ipsilateral ejaculatory duct obstruction is known as Zinner syndrome. Congenital anomalies of the seminal vesicles are rare; some of them are associated with malformations of the upper urinary system. Seminal vesicle cysts are associated with ipsilateral renal agenesis and ectopic or dysplastic ureter. Patients may remain asymptomatic and be diagnosed incidentally or may present with symptoms such as increased urinary frequency, dysuria, recurrent infections, pain with ejaculation, and perineal discomfort.

Sperm retrieval by conventional testicular sperm extraction for assisted reproduction in patients with Zinner syndrome

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.

A wide spectrum of rare clinical variants of Zinner syndrome

Congenital malformations of the seminal vesicles (SVs) are rare and are associated with abnormalities of the ipsilateral urinary tracts as embryologically both the ureteral buds and SVs arise from the mesonephric ducts. The triad of SV cysts, ipsilateral renal agenesis and ejaculatory duct obstruction is known as the Zinner syndrome. We, herein, present three very rare presentations of Zinner syndrome. Case 1 presented with haematuria, and was found to have a large SV cyst with stones and underwent a robotic cyst excision. Case 2 presented with primary infertility, and was found to have a variant of Zinner syndrome. Case 3 was a known case of chronic kidney disease on maintenance haemodialysis who presented with fever and oliguria. He was found to have Zinner syndrome and underwent aspiration of SV abscess. To the best of our knowledge, such varying presentations of Zinner syndrome have been rarely reported thus far.

Zinner’s Syndrome: A Rare Diagnosis of Dysuria Based on Imaging

Zinner's syndrome is a rare congenital malformation of the seminal vesicle and ipsilateral upper urinary tract, due to developmental arrest in early embryogenesis of the Müllerian duct. Clinical presentation is nonspecific and includes voiding symptoms such as dysuria, ejaculatory disorders, and hypogastric or perineal pain. The diagnosis is made with imaging techniques, notably Magnetic Resonance Imaging (MRI) which remains the gold standard exam for diagnosis confirmation and therapeutic management. Treatment options depend on the severity of symptoms, the size of the cyst, and the complications. Herein, we report a rare case of a 33-year-old young patient who presented recurrent dysuria and ejaculatory disorders for the last 5 years. Imaging studies revealed an empty left renal fossa, with cystic pelvic mass related to the seminal vesicle and which was compatible with the diagnosis of Zinner's syndrome. The patient underwent successful laparoscopic removal of the cyst and seminal vesicle, with total disappearance of urinary and sexual complaints with a 3-year follow-up.

Zinner syndrome and infertility─a literature review based on a clinical case

Zinner syndrome (ZS) is a rare congenital malformation associated with seminal vesicle cysts, ejaculatory duct obstruction, and ipsilateral renal agenesis. The main treatment focus so far has been on symptomatic patients. Therefore, surgery has been reserved for these patients, and surgical treatment is mainly aimed at pain relief. ZS seems to be frequently associated with infertility, but diagnosing is challenging, particularly during adolescence. This literature review of ZS and infertility is based on the medical report of one adolescent patient.

Congenital and hereditary cystic diseases of the abdomen

Congenital and hereditary cystic lesions of the abdomen are relatively rare. Correct diagnosis is critical as they may simulate several other benign and malignant acquired diseases of the abdomen. With the correct and appropriate use of imaging, diagnosis may be relatively straightforward and clinical management may be implemented appropriately. The purpose of this article is to describe imaging findings of common and uncommon congenital and hereditary cystic disease of the abdominal organs.

Cross-sectional imaging of seminal vesicles and vasa deferentia

A wide spectrum of pathologies, ranging from inconsequential degenerative and senile changes to clinically significant neoplasms, can affect seminal vesicles (SVs). With rapid rise in use of magnetic resonance imaging for evaluation of prostate in recent years an increasing number of cases of incidental SV pathologies are encountered by radiologists. Despite the high contrast resolution and high spatial resolution offered by multiparametric pelvic MRI, accurate diagnosis of SV processes can at times be challenging. In this article, we review the anatomy and embryology of the SVs and vasa deferentia and then explore the spectrum of diseases affecting them.

Robotic management of painful Zinner syndrome, case report and review of literature

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.

Zinner Syndrome Unmasked by Workup for Renal Colic and Uncontrolled Hypertension

Zinner syndrome is a rare hereditary disorder of the mesonephric duct. The triad of the absence of one kidney, ipsilateral cystic dilatation of the seminal vesicle, and ejaculatory duct obstruction makes the diagnosis. Mostly, it is asymptomatic. However, genitourinary manifestations and workup for the incidental absence of one kidney often uncover the disease. Ultrasound and CT scan can identify the absence of a kidney and seminal vesicle cyst, while MRI is the gold standard for diagnostic elaboration of the pelvic anatomy. In this article, we have presented a 51-year-old male patient who presented with renal colic and hypertension. Radiological investigations for the renal colic uncovered the diagnosis of Zinner syndrome incidentally. This case highlights the incidental nature, variability in the clinical presentation, and the diagnostic challenges of this rare disorder. It also emphasizes on the radiologist for a careful evaluation of the pelvic images in patients with unilateral absence of a kidney.

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’s Syndrome – The Value of Clinical Imaging and Morphopathological Findings for Diagnosis

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.

Infertility case presentation in Zinner syndrome: Can a long-lasting seminal tract obstruction cause secretory testicular injury?

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.

Zinner syndrome mimicking bladder outlet obstruction managed with aspiration

Zinner syndrome is a rare cystic malformation of seminal vesicle which consists a triad of unilateral renal agenesis, ipsilateral seminal vesicle cyst, and ejaculatory duct obstruction. The usual presentation is between the third and fourth decades of life, with infertility being the most common complaint. Ultrasound, cystoscopy, and magnetic resonance tomography (MRI) can easily detect this condition. Treatment option varies according to the presenting symptoms of the patient. We present a case of a 19-year-old male with recurrent episodes of urinary tract infection (UTI) and poor urinary stream. On ultrasound examination, the patient was found to have absent right kidney with a cystic swelling noted to be arising from prostate or seminal vesicle region which was further confirmed on MRI examination. Cystoscopy reveals a bulge on the right side of the verumontanum abutting the neck of the bladder. An ultrasound-guided aspiration of the cyst was performed which relieved the symptoms of the patient. Cystic abnormalities of the seminal vesicle are very uncommon. Symptomatic cases may present as recurrent UTI, infertility, bladder outlet obstruction, and painful ejaculation. Surveillance may be the option in the absence of clinical manifestations. Interventions such as image-guided aspiration or surgical procedures are appropriate when conservative measures prove ineffective.

Incidental finding of Zinner syndrome in a Greek military recruit: a case report of a rare clinical entity

BACKGROUND

Zinner syndrome represents a rare congenital malformation of the urinary tract. It comprises a constellation of Wolffian duct anomalies and is almost exclusively encountered as a classic triad of seminal vesicle cysts, ejaculatory duct obstruction and renal agenesis. Patients can be either asymptomatic or symptomatic. Recently, minimally invasive surgical techniques have emerged, superseding traditional surgery for select symptomatic cases. Our case highlights the finding of a rare clinical syndrome that was incidentally detected during a routine mass screening of military recruits in the Greek Armed Forces.

CASE PRESENTATION

Herein, we present a case of a 19-year-old male who reported having a solitary right kidney when examined in a military training center of Northern Greece. No additional clinical information was available; thus, referral to a tertiary urology department for further investigation ensued. Imaging studies, namely, computed tomography and magnetic resonance imaging, revealed left renal aplasia, multiple left seminal vesicle cysts, and ejaculatory duct obstruction. Laboratory values and urinalysis were within normal range. Semen analysis was significant for cryptozoospermia. Our patient remained asymptomatic during the entire hospitalization. Long-term follow-up was recommended. Nevertheless, he declined further investigation and sought treatment in a private practice setting.

CONCLUSIONS

This article aims to present the incidental diagnosis of a rare syndrome in a military setting. Population screening conducted in the armed forces permits the identification of undiagnosed diseases that warrant further investigation. To the best of our knowledge, this was the first report of Zinner syndrome in a military recruit and the second case cited of a Greek patient in the published literature. Regular follow-up is the key to timely intervention in conservatively managed cases.

Zinner Syndrome in Pediatric Age: Issues in the Diagnosis and Treatment of a Rare Malformation Complex

Zinner syndrome (ZS) is the association of congenital seminal vesicle cysts and ipsilateral upper urinary tract anomalies, such as multicystic displastic kidney (MCDK). This condition is rare in pediatric age and both diagnosis and treatment are challenging. The aim of this study was to analyze the issues in diagnosis, management, and treatment of ZS in pediatric age. The medical records of two patients with ZS were examined. Furthermore, a review of the literature on this topic in pediatric age was performed. In our experience the diagnosis of ZS was incidentally achieved in the first months of life, as a consequence of studies performed for a prenatal diagnosis of MCDK. The first patient presented unspecific and transient symptoms, the second infant was completely asymptomatic. They were conservatively treated, with a long-term follow-up planned at least until adolescence. Fifty cases of ZS in pediatric age have been reported in the literature up to now. Only 12/50 were diagnosed in the first year of life. The diagnosis was demanding, as the clinical presentation was unspecific and the results at imaging studies needed a differential diagnosis with other retrovesical masses. More than 80% of these cases were asymptomatic at long-term follow-up. Therefore, a conservative management of ZS has been accepted for asymptomatic or poorly symptomatic patients, with occasional, transient, and unspecific symptoms, such as urinary tract infections or orchyepididimytis. As the surgical management is challenging, it is proposed only in those symptomatic patients. In conclusion, ZS is rare in pediatric age. However, it should be considered in the differential diagnosis of cystic masses within the pelvis in males with ipsilateral renal anomalies. A conservative treatment with a long-term follow-up is a safe option in the management of asymptomatic or poorly symptomatic patients, thus reserving the surgical approach only in those cases with symptoms.

Zinner syndrome presenting with intermittent scrotal pain in a young man

Congenital malformations of the seminal vesicle are uncommon, and most of them are cystic malformations. If an insult occurs during the first trimester of gestation, the embryogenesis of the kidney, ureter, seminal vesicle, and vas deferens could be altered. The mutual embryological origins of the seminal vesicle and ureteral bud from the mesonephric (Wolffian) duct result in association between ipsilateral renal agenesis and seminal vesical cysts. Zinner syndrome is a rare condition comprising a triad of unilateral renal agenesis, ipsilateral seminal vesicle obstruction and ipsilateral ejaculatory duct obstruction. This syndrome were first described by Zinner in 1914, and 200 cases have been reported in the literature. Most patients with this anomaly are asymptomatic until the second or third decade of life. Some cases have nonspecific symptoms such as prostatism, urinary urgency, dysuria, painful ejaculation, and perineal discomfort. In this paper, we present a uncommon case of a 21-year-old patient which the initial presentation of this condition was intermittent scrotal pain. A brief review of the literature is undertaken, regarding the main clinical, imaging implications, and the developmental anomalies that are involved in this congenital anomaly.