Zinner and Mayer-Rokitansky-Küster-Hauser syndromes: when unilateral renal agenesis meets genital anomalies

Applicability and Suitability of the Embryological-Clinical Classification of Female Genital Malformations: A Systematic Review

Complex urogenital malformations are clinically highly relevant; thus, they must be appropriately diagnosed and classified before initiating treatment. Background/Objectives: This study aimed to evaluate the applicability and suitability of the embryological-clinical classification of female genital malformations. Methods: A systematic review of cases of genital malformations reported in the literature from 2000 to 2020 was conducted. Case reports and series with the following combinations: "female genital tract" AND (malformation OR anomaly OR müllerian anomaly OR uterine anomaly OR cervical anomaly OR vaginal anomaly OR cloacal anomaly OR urogenital sinus); and "female genital tract" AND (renal agenesis OR ectopic ureter) were searched. A total of 3124 articles were identified, of which 824 cases of genital malformation were extracted. The characteristics of each malformation were included in a database for further analyses. Results: Using the embryological-clinical classification, 89.9% of the published cases and 86.5% of the 52 cases defined as unclassifiable by their authors have been classified in this review. In 73 cases (72.2%), the classification of the malformation using the AFS system was incomplete because although the type of uterine anomaly of the AFS classification matched that of the embryological-clinical classification, characteristics of the urinary system or the vagina were overlooked when using the AFS system. Following a dispersion matrix, we have been able to show that the embryological-clinical classification system is able to classify and subclassify the genitourinary malformations more accurately. Conclusions: The applicability of the embryological-clinical classification has been confirmed after classifying most of the cases of genital malformation previously published. This system also provides a more complete and accurate classification than other classifying systems exclusively based on Müllerian duct development or uterovaginal parameters, demonstrating its suitability.

The role of radiology in diagnosis of Zinner syndrome in a young man with scrotal pain

Zinner Syndrome is a rare congenital anomaly. It is considered a rare cause of male infertility and can cause a range of clinical manifestations that may lead to significant morbidity. The diagnosis of Zinner Syndrome requires a high index of suspicion, combined with a detailed clinical evaluation and imaging studies. Ultrasonography, computed tomography, and MRI are the imaging modalities of choice for the diagnosis of this condition. Radiological evaluation also plays a crucial role in the management of Zinner Syndrome. In symptomatic cases, surgical intervention may be necessary, and radiology is essential for surgical planning and postoperative monitoring. In this case report, we describe an uncommon case of a 35-year-old patient with vague scrotal pain and discuss the clinical presentation, diagnosis, and management of this rare condition. Prompt and accurate diagnosis is important to prevent the potential morbidity associated with this condition, such as recurrent epididymitis, urinary tract infections, and infertility.

Zinner's Syndrome: Case report of a Developmental Anomaly of the Mesonephric Duct

Zinner's syndrome is a rare congenital malformation characterized by the association of unilateral renal agenesis with ipsilateral seminal vesicle cyst and ejaculatory duct obstruction. Most patients are asymptomatic until the third or fourth decade of life when the syndrome is associated with dysuria, perineal pain, infertility, and painful ejaculation. In this report, we present the common imaging findings of this rare developmental anomaly involving the mesonephric duct in a 48-year-old male patient experiencing pelvic pain, recurrent dysuria, and pollakiuria.

Laparoscopic excision of huge seminal vesicle cyst in Zinner syndrome

This is the case of a 45-year-old male who presented with dysuria and gross hematuria. Ultrasonography and computed tomography revealed an enormous pelvic cystic lesion and a right nephromegaly but an invisible left kidney. Using the imaging findings, the patient was diagnosed with Zinner syndrome. Transperitoneal laparoscopic excision of the cyst was performed for symptom relief. At post-treatment, the symptoms disappeared, and sexual function remained. Seminal vesicle cysts have been commonly reported in previous studies but rarely in this case. Furthermore, most previous studies have documented surgical excision of <10 cm cysts. However, a ∼12.5-cm seminal vesicle cyst was excised with the laparoscopic method without any perioperative complication in this case.