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

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.

Zinner Syndrome—A Rare Cause of Recurrent Epididymitis and Infertility

“…The decreased semen parameters may be due to atresia of the ejaculatory tract, the presence of a hematoma in the seminal vesicle, or it may be secondary to inflammation of the genitourinary system [ 5 ]. The most common deviations are low semen volume (hypospermia) and no sperm in the ejaculate (azoospermia) [ 7 ]. Therefore, according to Kori et al [ 4 ], all patients we intend to introduce surgical treatment should undergo a semen analysis.…”

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

“…From a pathophysiological standpoint, ZS can be associated with seminal tract obstruction, and secretory damage may occur due to the presence of a long-lasting blockage to sperm outflow [6]. Although TURED represents the first-line treatment in patients with EDO to restore fertility and improve sperm quality, testicular fine-needle aspiration, epididymal percutaneous sperm aspiration, or TESE are effective options to obtain viable spermatozoa.…”

“…Long-lasting obstruction (that is, that lasts for several years) has been proposed to potentially cause germ cell failure in the spermatogenetic tubules [6]. The elevated concentrations of macrophages and sperm fragments in the distal epididymis may affect the sperm quality [17].…”

“…Patients with ZS are often asymptomatic, although aspecific signs may be present such as pelvic pain, painful ejaculation, urinary frequency, dysuria, urgency, constipation, recurrent urinary tract infections, or epididymitis [6]. As a consequence of the wide range of symptoms of this syndrome, the diagnosis of infertility can be de-layed, and ZS requires prompt management upon proper diagnosis.…”

“…As a consequence of the wide range of symptoms of this syndrome, the diagnosis of infertility can be de-layed, and ZS requires prompt management upon proper diagnosis. Semen evaluation is unlikely to reveal absolute azoospermia, but commonly reveals obstructive azoospermia (OA), although secretory damage may also be present due to a long-lasting obstruction to sperm outflow [6]. While the surgical removal of seminal vesicle cysts [7] or transurethral resection of the ED (TURED) may improve sperm quality [8], testicular fine needle aspiration, epididymal percutaneous sperm aspiration, and testicular sperm extraction (TESE) may be crucial to obtain viable spermatozoa and allow a chance of conception.…”