Long-Term Surveillance and Laparoscopic Management of Zinner Syndrome

Abstract

Zinner syndrome was first described in 1914 and represents the triad of unilateral renal agenesis and ipsilateral seminal vesicle cyst and ipsilateral ejaculatory duct obstruction. Seminal vesicle cysts are often asymptomatic but can also present with pain, haematospermia, or other lower urinary tract symptoms. Treatment strategies include observation and surgical excision. We present the laparoscopic management of an enlarged seminal vesicle cyst, consistent with Zinner syndrome, 14 years after the initial diagnosis. A 58-year-old male patient was diagnosed with a left-sided seminal vesicle cyst while undergoing assessment for renal transplant due to progressively worsening renal function in his solitary right kidney. The otherwise asymptomatic cyst enlarged from the time of initial diagnosis in 2004 ( 11.3 cm × 9.7 cm × 13.1 cm ) to nearly double the size in 2018 ( 12.8 cm × 11.9 cm × 14.2 cm ). This cyst size ultimately precluded renal transplant, and the patient was referred for excision. Laparoscopic excision of the cyst was performed, histopathology confirmed seminal vesicle cyst tissue, and there has been no recurrence of the cyst to date. The patient remains active on the renal transplant waitlist. Zinner syndrome is a rare syndrome, with the seminal vesicle cysts being managed by observation or surgical excision. We report the longest documented observation of a seminal vesicle cyst, culminating in a safe and successful laparoscopic excision.

Zinner syndrome: A first case report from Ethiopia

“…Small size seminal vesicle lesions with no symptoms can be observed with regular follow up. The majority of seminal vesicle cysts described in Zinner syndrome are benign in nature with only single reported case of malignant seminal vesicle in a 28-year-old patient [10 , 11] . The longest documented follow up for a known Zinner syndrome patient was for 17 years with 80% increment in size of the lesion over the course [10] .…”

“…The types of surgery that was done was seminal vesiculectomy with different approaches including open surgery, laparoscopic, or robot assisted surgery [3] . Aspiration was the other management option but it is associated with high degree of recurrence [10] . In patients who presented with infertility as a presenting symptom the preferred management option of transurethral resection of the ejaculatory duct [10] .…”

“…Aspiration was the other management option but it is associated with high degree of recurrence [10] . In patients who presented with infertility as a presenting symptom the preferred management option of transurethral resection of the ejaculatory duct [10] . Small size seminal vesicle lesions with no symptoms can be observed with regular follow up.…”

An unusual cause of painful ejaculation in a young patient: Zinner syndrome

“…In patients with symptoms, the therapeutic management of the cyst includes ultrasound-guided aspiration and transurethral detachment of the ejaculatory duct and seminal vesicular cyst [ 2 , 4 ]. Currently, laparoscopic surgery seems to be the most appropriate for surgical treatment of seminal vesicle cysts [ 6 ]. It has the advantage of direct access to the seminal vesicle with excellent depth imaging compared to open surgery.…”

“…It has the advantage of direct access to the seminal vesicle with excellent depth imaging compared to open surgery. Removal of the seminal vesicle cysts can resolve symptoms while preserving fertility and erectile function [ 2 , 6 ]. Our patient has an open surgical excision of a cyst.…”