Laparoscopic Surgery for Seminal Vesicle Cysts and Ureterocele with Urination Disorder: A Case Report of Zinner Syndrome.

Takeshi Maehana,Ko Kobayashi,Fumimasa Fukuta,Megumi Hirobe,Naoya Masumori,Toshiaki Tanaka

doi:10.1089/cren.2018.0008

Takeshi Maehana, Ko Kobayashi + Show 4 more

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https://doi.org/10.1089/cren.2018.0008

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Abstract

Background: Zinner syndrome is defined as seminal vesicle cysts with ipsilateral renal agenesis and an ectopic ureter. Symptomatic cases are very rare. In this article, we present a laparoscopic approach for a case of Zinner syndrome.Case Presentation: The patient was a 21-year-old male with difficult urination. A right seminal vesicle cyst and right kidney agenesis associated with ureterocele were found on examination and he was diagnosed with Zinner syndrome. First, we performed transperineal puncture of the ureterocele because it closed the bladder neck during voiding. Although voiding symptoms temporarily improved, the ureterocele recurred soon and the urination disorder was reexacerbated. Next, we selected laparoscopic removal of the ureterocele and the seminal vesicle cyst. The procedure was performed with transperitoneal access using four trocars. Perioperative and postoperative complications were not observed, and micturition was satisfactory after surgery.Conclusion: Treatment for difficult urination because of Zinner syndrome is mostly selected puncture of the ureterocele or seminal vesicle cyst. However, some patients experience recurrence. The laparoscopic approach is minimally invasive and provides a satisfactory surgical field. Therefore, it should be considered the method of treatment for symptomatic Zinner syndrome.

Highlights

Renal agenesis associated with ipsilateral seminal vesicle cysts, an ectopic ureter opening into the seminal vesicle, and obstruction of the ejaculatory duct is a Wolffian duct anomaly known as the Zinner syndrome.[1]
We present the first case of a Japanese patient who was managed successfully through a laparoscopic removal of a large seminal vesicle cyst and ipsilateral renal agenesis with ureterocele
The ureterocele was dissected so as to peel it from the bladder muscle layer, and the right ureter, seminal vesicle cyst, and right vas deferens were extracted en bloc from the dorsal side of the prostate

Summary

Introduction

Renal agenesis associated with ipsilateral seminal vesicle cysts, an ectopic ureter opening into the seminal vesicle, and obstruction of the ejaculatory duct is a Wolffian duct anomaly known as the Zinner syndrome.[1]. Slightly >200 cases of Zinner syndrome have been described in the literature based on imaging and pathologic examinations This syndrome is generally asymptomatic, it may cause symptoms such as perineal pain, painful ejaculation, hematospermia, abnormal micturition, lower urinary tract symptoms, and dysuria.[3] If there are any symptoms, the treatment options are surgical resection, puncture, aspiration, and transurethral resection. We present the first case of a Japanese patient who was managed successfully through a laparoscopic removal of a large seminal vesicle cyst and ipsilateral renal agenesis with ureterocele. Multiple enlarged seminal vesicle cysts were imaged from near the ampulla of the ductus vas deferens; a ureterocele and the right ureter were visualized subsequently (Fig. 3a, b). The ureterocele was dissected so as to peel it from the bladder muscle layer, and the right ureter, seminal vesicle cyst, and right vas deferens were extracted en bloc from the dorsal side of the prostate.

Discussion

Conclusion