Zinner's syndrome is a rare condition that can be challenging to diagnose and manage. Limited knowledge about its natural history and optimal treatment further complicates matters. To shed more light on this condition, we present a case series of three patients with Zinner's syndrome, highlighting their clinical presentations, diagnostic workup, and treatment options. Our first patient was a 16-year-old male with left epididymo-orchitis and left renal agenesis. The second patient was a 25-year-old male with left epididymo-orchitis, left seminal vesicle cyst, and left renal agenesis. The third patient was a 65-year-old male with left seminal vesicle cysts and aplastic ectopic renal tissue with ectopic ureteral insertion into the seminal vesicle cyst causing acute urinary retention. The two patients who presented with epididymo-orchitis were managed conservatively while the one presenting with acute urinary retention required surgical exploration and excision. It is noted that diagnosis of Zinner's syndrome requires a high index of suspicion, and radiological imaging is crucial for confirmation. Surgical intervention is often necessary to treat symptomatic compression, and fertility counselling is necessary due to the potential for impaired semen quality. Close monitoring is needed due to the risk of renal impairment in the future.

Crossed fused renal ectopia (CFRE), second most common renal fusion anomaly of the kidney. These patients were mostly asymptomatic and present with complaints due to associated conditions. The management of these conditions was complicated not only by the approach to be picked, but also by the investigation to be performed. The following study was done at a tertiary care centre, with the duration of this study being from January 2019 to April 2021. A total of twelve patients with CFRE required surgical intervention for their symptoms during this period. As a routine history, routine investigations and ultrasound (US) of the abdomen and pelvis was followed for all the patients. Other imaging modalities were opted on case to case basis. Out of n=12 patients of CFRE with fusion who underwent surgical intervention, majority were male patients (n=10). The most common symptom was abdominal pain (n=9). The most common crossed renal ectopia was the left to right fusion (n=7), as compared to right to left CRE (n=5). The most common fusion anomaly was L-shaped (n=8). The endourological procedures (n=6), laparoscopic procedures (n=2) while open procedures (n=4). It is important for a urologist to bear in mind the various presentations of this less known anomaly with diverse presentations. We have highlighted the investigations used at our center which would help plan further treatment and surgical approach in such patient in view of complex renal as well as vascular anatomy.