V03-06 ZINNER SYNDROME, ROBOTIC MANAGEMENT IN PEDIATRIC PATIENTS WITH SEMINAL VESICLE CYSTS

Abstract

You have accessJournal of UrologyPediatrics (V03)1 Sep 2021V03-06 ZINNER SYNDROME, ROBOTIC MANAGEMENT IN PEDIATRIC PATIENTS WITH SEMINAL VESICLE CYSTS Igor Voznesensky, Thomas Shelton, Joseph Allen, Ihor Yosypiv, Erik Castle, and Aaron Martin Igor VoznesenskyIgor Voznesensky More articles by this author , Thomas SheltonThomas Shelton More articles by this author , Joseph AllenJoseph Allen More articles by this author , Ihor YosypivIhor Yosypiv More articles by this author , Erik CastleErik Castle More articles by this author , and Aaron MartinAaron Martin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001991.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Zinner Syndrome is a rare congenital abnormality of the mesonephric (Wolffian) duct consisting of the triad of unilateral renal agenesis, ipsilateral seminal vesicle cyst and ipsilateral ejaculatory duct obstruction. While most patients with this anomaly are asymptomatic until the second or third decade of life, some may report nonspecific symptoms such as urinary urgency, dysuria, painful ejaculation, and perineal discomfort. Surgical resection of the cyst and the seminal vesicle is often necessitated because of the high rate of recurrence after conservative treatment. METHODS: Using the DaVinci robotic surgical system, we performed minimally invasive surgical management for two Zinner Syndrome patients, aged 14 and 17. For both procedures, cystoscopy was first utilized to identify the large posterior extravesical cystic masses and to cannulate the normal healthy contralateral ureter with a safety wire. We then incised the peritoneum, identifying and mobilizing the remnant distal ureteral stump and tracing towards the vas deferens. Once the seminal vesicle cyst was identified and mobilized from surrounding tissues, we proceeded to excise the SV cyst in its entirety. Due to the thin walled nature of the seminal vesical cyst in both patients, a small cystotomy was necessitated to facilitate complete excision. The cystotomy was then closed in standard fashion with pre-placed sensor wire used to facilitate identification and preservation of normal contralateral ureter. Lastly, the peritoneum was then reapproximated with running absorbable suture. RESULTS: Both patients were sent home the day following surgery. Post op imaging showed resolution of the seminal vesicle cysts and the patients reported symptomatic relief. Pathology demonstrated benign urothelium and underlying fibromuscular stromal tissue along with a portion of benign ureter. CONCLUSIONS: Using technology such as the DaVinci robot we can offer pediatric patients a minimally invasive approach for management even in the setting of rare pelvic pathology and clinical presentations. Source of Funding: n/a © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e224-e224 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Igor Voznesensky More articles by this author Thomas Shelton More articles by this author Joseph Allen More articles by this author Ihor Yosypiv More articles by this author Erik Castle More articles by this author Aaron Martin More articles by this author Expand All Advertisement Loading ...