Ultrasonic diagnosis of seminal vesicle cyst

Zinner's syndrome: report of two cases and review of the literature

BACKGROUND

Congenital malformations of the seminal vesicle are uncommon, and most of them are cystic malformations. If an insult occurs between the 4th and the 13 h gestational week, the embryogenesis of the kidney, ureter, seminal vesicle, and vas deferens could be altered. Cysts of the seminal vesicle may appear with a mass effect, dysuria, epididymitis, or obstruction of the gastrointestinal and genitourinary tracts. Approximately two thirds of them are associated with ipsilateral renal agenesis, because both the ureteral buds and seminal vesicles originate from the mesonephric (Wolffian) duct. They were first described by Zinner in 1914, and 200 cases of seminal vesicle cysts associated with ipsilateral renal agenesis have been reported in the literature. Most patients with this anomaly are asymptomatic until the third or fourth decade of life. Some cases have nonspecific symptoms such as prostatism, urinary urgency, dysuria, painful ejaculation, and perineal discomfort. Transrectal ultrasonography provides good visualization of the pelvic structures and allows guidance for aspiration of the cysts.

CASE PRESENTATION

We present two cases of seminal vesicle cyst. The first patient had dysuria, increased frequency of urination, and haematuria. He was operated and benefited from a removal of the cyst with right ureterectomy and left ureteral reimplantation. The second patient had disorder of the digestive transit and he benefited from a laparoscopic removal of the cyst.

CONCLUSIONS

Seminal vesicle cysts combined with ipsilateral renal agenesis are rare urological anomalies. Usual symptoms that are caused by the seminal vesicle cysts are bladder irritation and obstruction as well as pain in the perineum and scrotum. Epididymitis is frequently found. Treatment consists to removing the seminal vesicle cyst.

Zinner syndrome: an uncommon cause of painful ejaculation

Zinner syndrome refers to the triad of ipsilateral renal agenesis, seminal vesicle cysts and ejaculatory duct obstruction. Ipsilateral renal agenesis may be associated with seminal vesicle cysts in 70% of cases, but a remnant ureteral bud has been shown to coexist in only 27% of these cases. While some patients may remain asymptomatic and are discovered incidentally, others present with symptoms related to seminal vesicle cysts or ejaculatory duct obstruction: voiding or ejaculatory difficulty or pain. The diagnosis is made with imaging findings, and differentiation from other pelvic cysts requires a multimodality approach. In this report, we present typical imaging findings of a patient who presented with painful ejaculation where there was a congenital seminal vesicle cyst with ipsilateral renal agenesis associated with a remnant ureteral bud draining into the seminal vesicle cyst and also associated with a cyst of the prostatic utricle. We discuss the relevant embryological basis for this unusual combination of findings.

Seminal vesicle cyst with ipsilateral renal agenesis

OBJECTIVE

The purpose of this study was to review the clinical symptoms and imaging features of a seminal vesicle cyst associated with renal agenesis.

CONCLUSION

Patients with seminal vesicle cysts associated with renal agenesis may present with symptoms of bladder irritation or obstruction and with an abdominal or pelvic mass revealed on physical examination. Differentiation of a seminal vesicle cyst from other pelvic cystic masses may be determined with a spectrum of imaging techniques including excretory urography, sonography, CT, and MR imaging.

Ultrasonographic characteristics of the seminal vesicles after ejaculation

A total of 12 men from a sperm donor bank underwent transrectal ultrasonography before and after ejaculation to investigate possible changes that could influence interpretation of seminal vesicle ultrasonography. The mean length of the seminal vesicles was 2.98 cm. before and 2.95 cm. after ejaculation. The anteroposterior diameter decreased only from 0.59 to 0.52 cm. Minimal differences were noted between the right and left seminal vesicles, and the greatest variation in size in an individual was only 3 mm. These results indicate that interpretation of seminal vesicle anatomy as seen by ultrasonography does not depend upon the temporal relationship to ejaculation.

Seminal vesicle abscesses: spectrum of computed tomographic findings

The computed tomographic (CT) findings in four cases of seminal vesicle abscess are presented. The predominant infectious organism in two cases was Escherichia coli, one case was probably caused by Mycobacterium tuberculosis, and another by atypical mycobacterium. The CT findings included unilateral (three cases) or bilateral involvement (one case), seminal vesicle enlargement with hypodense areas within the gland (three cases), adjacent perivesicle inflammation (three cases), and associated bladder wall thickening (three cases). Although the diagnosis of seminal vesicle abscess is often overlooked clinically, CT may help suggest the correct diagnosis early thereby helping to initiate therapy.

Successful transurethral drainage of bilateral seminal vesicle abscesses

We report the successful management of bilateral seminal vesicle abscesses with transurethral unroofing and drainage of the abscess cavities. The diagnosis was confirmed by computerized tomography. Transurethral drainage became necessary after percutaneous drainage had proved to be inadequate.

Computed tomography of the normal seminal vesicles

Fifty patients without pelvic pathology were studied in order to determine the normal appearance of the seminal vesicles on computed tomography (CT). The seminal vesicles could be identified in all patients. The mean length of each seminal vesicle was 3.1 +/- 0.5 cm and the mean width was 1.5 +/- 0.4 cm. Calculated areas of the seminal vesicles assuming an ellipsoid shape were 3.6 +/- 1.1 cm2 for each side. When correlated with patients' ages, no significant difference was identified between age and the length of the seminal vesicles, however, a significant difference was noted between the widths (P less than 0.01) and areas (P less than 0.05) of the seminal vesicles with patients of increasing age having smaller seminal vesicles. In 67% of patients these structures were symmetrical and in 33% some degree of asymmetry was noted. Variability in shape ranged from ovoid (70%), tubular (20%), and rounded (10%). In 48 of 50 patients, small punctate densities could be seen along the lateral aspects of both seminal vesicles which correspond to the anatomic region of the pudendal venous plexus.

Nongynecologic bladder and perivesical ultrasound

Ultrasound is effective in evaluating pathologic entities in and around the urinary bladder. Abnormalities may be classified into 2 groups: lesions primarily affecting the bladder, including the bladder wall; and perivesical lesions, which secondarily affect the urinary tract. Intrinsic bladder diseases include inflammatory lesions, stones, and tumors, both primary and metastatic. Extrinsic perivesical abnormalities include lesions of the prostate, seminal vesicles, urethra, rectum, and perivesical soft tissues. Since the bladder is routinely visualized on pelvic ultrasonography, awareness and recognition of the ultrasonic appearance of disease in and around the urinary bladder can lead to more accurate diagnosis and detection of unsuspected disease.

Transabdominal sonography of seminal vesicles

We evaluated 119 male patients for infertility and/or prostatitis. Transabdominal sonography of the seminal vesicles was performed and transverse sections were used to measure the height and breadth. A correlation was established with the characteristics of the semen, the volume of semen being related directly to the size of the vesicles. Male patients with semen abnormalities had seminal vesicles of greater diameters than those with normal semen. When patients with prostatitis are eliminated from this group the difference is insignificant.

Computed tomography and ultrasonography in the evaluation of mesonephric duct anomalies

Three cases involving developmental anomalies of mesonephric duct derivatives were examined by computed tomography and ultrasonography. Cases included an ectopic ureter inserting into a cystic seminal vesicle, an ectopic ureterocele, and agenesis of the seminal vesicle and vas deferens. Computed tomography and ultrasonography were valuable noninvasive methods, supplementing standard radiographic techniques, for evaluating these anomalies.

Cyst of seminal vesicle associated with ipsilateral renal agenesis. A report on four cases

Four cases of seminal vesicle cyst associated with agenesis of the ipsilateral kidney are presented. The literature and the embryologic development of this rare anomaly are briefly surveyed.