Zinner syndrome mimicking bladder outlet obstruction managed with aspiration

Abstract

Zinner syndrome is a rare cystic malformation of seminal vesicle which consists a triad of unilateral renal agenesis, ipsilateral seminal vesicle cyst, and ejaculatory duct obstruction. The usual presentation is between the third and fourth decades of life, with infertility being the most common complaint. Ultrasound, cystoscopy, and magnetic resonance tomography (MRI) can easily detect this condition. Treatment option varies according to the presenting symptoms of the patient. We present a case of a 19-year-old male with recurrent episodes of urinary tract infection (UTI) and poor urinary stream. On ultrasound examination, the patient was found to have absent right kidney with a cystic swelling noted to be arising from prostate or seminal vesicle region which was further confirmed on MRI examination. Cystoscopy reveals a bulge on the right side of the verumontanum abutting the neck of the bladder. An ultrasound-guided aspiration of the cyst was performed which relieved the symptoms of the patient. Cystic abnormalities of the seminal vesicle are very uncommon. Symptomatic cases may present as recurrent UTI, infertility, bladder outlet obstruction, and painful ejaculation. Surveillance may be the option in the absence of clinical manifestations. Interventions such as image-guided aspiration or surgical procedures are appropriate when conservative measures prove ineffective.

Giant seminal vesicle cyst with hemorrhage in Zinner syndrome: A case report

“…Surgical methods include transrectal and perineal seminal vesicle cysts puncture and drainage, open seminal vesicle cystectomy, laparoscopic and robot-assisted seminal vesicle cystectomy, etc. [2,15,16] Because of the deep location of the seminal vesicles in the retrovesical space, traditional open surgery field exposure is poor, and it has significant trauma, slow recovery, and postoperative complications. Therefore, open surgical access is technically challenging.…”

Zinner Syndrome—A Rare Cause of Recurrent Epididymitis and Infertility

“…The differentiation process takes place between the 4th and 13th week of intrauterine life and is under control by testosterone and the Anti-Mullerian hormone (AMH). The development of the fetal kidney from the mesoderm is dependent on the ureteric bud, which comes from the Wolff’s duct [ 1 , 4 ]. The disturbing process at this stage explains the one-sided and related nature of these changes.…”

“…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.…”

“…To date, there are no official guidelines for the treatment of Zinner syndrome. Due to the limited number of cases, it is currently difficult to state the superiority of one of the methods [ 4 ]. Together with the patient, we decided about transrectal cyst aspiration.…”

Zinner’s syndrome: to observe or to operate? a triplet of cases with varying clinical presentation

“…Patients with this syndrome may present with a range of symptoms, including lower abdominal pain, dysuria, hematuria, epididymoorchitis or infertility. [2][3][4][5][6] In rare scenarios, this condition can mimic a varicocele and present as a scrotal swelling. 7 These myriads of clinical presentations associated with Zinner's syndrome highlight the heterogeneity of this rare condition.…”