Wolffian Duct Research Articles

Atypical Presentation and Delayed Diagnosis of Herlyn-Werner-Wunderlich Syndrome: A Case Report and Literature Review

Herlyn-Werner-Wunderlich syndrome (HWWS) is a rare and complex Mullerian duct abnormality that is diagnostically challenging. It is also known as OHVIRA syndrome. The triad of uterine didelphys, obstructed hemivagina and ipsilateral renal anomaly characterises the syndrome. A 25-year-old lady was referred with prolonged foul-smelling vaginal discharge. Her periods were regular with normal flow. A vaginal examination revealed a normal cervix and fullness of left adnexa. A pelvic ultrasound showed a left adnexal mass. Computed tomography imaging of the abdomen and pelvis revealed two uterine cavities with a large cystic lesion at the level of the cervix. This lesion was communicating with the uterine cavity, raising the possibility of obstruction. Only the right kidney was present. A diagnosis of HWWS was made. The patient underwent diagnostic laparoscopy, examination under anaesthesia and excision of the vaginal septum. At follow-up, she remained well at 6 weeks and 3 months. The normal mesonephric duct plays an important role in the formation of the uterus, vagina and the upper urinary tract. HWWS occurs when one of the mesonephric ducts is absent or injured during embryogenesis. Women with HWWS usually present after menarche with varied symptoms, causing delays in diagnosis and treatment. Therefore, having a high suspicion index and awareness of Mullerian duct abnormalities is crucial. The gold standard for the evaluation of HWWS is magnetic resonance imaging. Surgical excision of the septum is the advocated treatment of choice. Prompt intervention lowers complications that impair fertility.

DEVELOPMENT OF THE PERINEUM STRUCTURES IN THE EMBRYONIC AND PREFETAL PERIODS

Traditionally, it is believed that the division of the cloaca into the ventral genitourinary pert and the dorsal - ureteric part occurs at the expense of the urorectal septum during the fourth week of intrauterine development. The separation of the cloaca finally ends during the sixth week of fetal development, with the fusion of the urorectal septum with the cloaca membrane. During the seventh week, both departments become separate entities. However, a significant cohort of authors question the traditional view of the mechanisms of cloacal separation.Purpose to establish and visualize the mechanism of cloaca division; to resolve the controversy regarding the role of the urorectal septum in the separation of the cloaca; to reveal the beginnings of future organ complexes of the male perineum.Material and method. Series of sections of 15 embryo preparations (4-7 weeks of gestational age; 4.5-13.5 mm. PCL) and 15 preparations of pre-fetus (7-9 weeks of gestational age; 14.0-35.0 mm. PCL) were studied by the methods of morphological research: microscopy, morphometry. In order to more accurately visualize and understand the processes of formation of the structures of the male perineum, the method of three-dimensional visualization was used.The results of own research. We found a significant number of mitotic divisions in the dorsal and lateral parts of the mesodermal tissue around the cranial part of the cloaca, but the absence of mitotic divisions was observed in the cells of the mesodermal tissue of the urogenital septum. The urorectal septum becomes visible after the cloacal folds separate the cloaca from the hindgut, distal to the junction between the mesonephric ducts and the cloaca. We established that from the 36th day of intrauterine development, an abdominal cavity is formed, which is located inside the urorectal septum and extends in the caudal direction distally from the point of entry of the mesonephric ducts to the middle of the distance between the entrance of the mesonephric ducts and the caudal top of the urorectal septum. On the 41st day of intrauterine development, parts of the mesonephric ducts, which are located between the cloaca and the ureteric buds, gradually disappear. Thus, both ureters and mesonephric ducts have a common entrance to the genitourinary sinus. Taking into account our observations, it should be noted that the division of the cloaca is a direct consequence of the growth and increase in the volume of the mesenchymal tissue that surrounds the cloaca and, especially in the later stages, its ventral part - the genitourinary sinus. During the 6-9th week of intrauterine development, the genitourinary sinus and urinary bladder are formed along with the demarcation of the mesonephric ducts and ureters.Conclusions. We identified three main structures that indirectly affect the division of the cloaca: after the formation of the urorectal septum, a decrease in the frequency of mitotic divisions of the latter is noted, which indicates its temporary and initial role in the division of the cloaca. Disproportionate growth and increase in the volume of mesenchymal tissue of the ventral part and dorsal part of the cloaca significantly affects the change in its shape and its division. The urorectal septum is not a single, separate structure and extends laterally. Finally, role of the abdominal cavity in the distribution of the cloaca is uncertain.

Vaginal Bulge is Not Always Prolapse

ObjectiveThe objective of this video is to review a case of a patient that presented to urogynecology clinic for prolapse, but was noted to have anterior vaginal cyst. In this video we review differential diagnosis, embryologic origin of vaginal cyst, excision procedure, imaging and pathology of the vaginal cyst. SettingUrogynecology clinic/operating room ParticipantPatient who presented with anterior vaginal cyst Intervention34yo G0 referred to Urogynecology for a vaginal bulge. On exam she had a 4 cm anterior vaginal cystic mass. The differential diagnosis for benign vaginal cysts is broad including Müllerian or Gartner's (mesonephric) ducts, Skene duct, Bartholin gland, epidermal inclusion, or endometriotic cysts, adenosis, or urethral diverticulum (1,2). Most are secondary to embryological remnants or trauma (3).Müllerian ducts form the fallopian tubes, broad ligament, uterus, cervix and upper part of the vagina. Müllerian epithelium is replaced with squamous epithelium of the urogenital sinus; however, Müllerian epithelium can persist anywhere along the vaginal wall. Thus, Müllerian cysts can be found at any location in the vagina (4).During vaginal cyst work-up, imaging can be helpful to further differentiate the cyst and aid in surgical planning. Our patient had an in-office translabial ultrasound that revealed a fluid filled vaginal cyst that had possible bladder connection. Pelvic MRI showed a 4 cm non-communicating fluid-filled cyst that was abutting the bladder in its entirety. We present imaging and a surgical excision video demonstrating the importance of meticulous dissection directly on the bladder wall. The video also presents histopathology slides with bland, endocervical-type columnar epithelium, leading to the final diagnosis of a Müllerian duct cyst. ConclusionVaginal cysts require careful examination and imaging. Understanding their location is crucial for surgical planning, counseling, and successful patient outcomes.

Metastatic Germ Cell Tumors Often Represent Continuous Evolving Processes (Somatic Transformation) toward SALL4-Positive Dominant Yolk Sac Tumors and Teratomas

Abstract Introduction/Objective SALL4 has been used to diagnose primary and metastatic germ cell tumors (GCT). However, it is not well established if SALL4 represents an evolving biomarker for GCT during the metastatic processes. Methods/Case Report We studied the fetal expression of SALL4 and a small series of metastatic GCT by comparing SALL4 expression (in all levels of GCT) with OCT3/4 expression (mainly in the early chain of germ cell tumors such as seminoma and embryonal carcinoma). Results (if a Case Study enter NA) First, we found SALL4 expression in Wolffian ducts and their surrounding stromal cells of 4 early embryos (5-7 weeks of gestation), implying that SALL4 may be involved in the early genital structure development. Then we identified 6 cases with metastatic GCT and compared SALL4 with OCT3/4 stains. The original tumors were all positive for both OCT3/4 and SALL4, but 4 out of 6 subsequently metastatic GCT stained positive only for SALL4 but not for OCT3/4. Particularly in case 5, the first two biopsies for metastatic GCT were positive for both biomarkers, but the last metastatic GCT to the gallbladders was positive only for SALL4. Conclusion Our pilot study raises the possibility that metastatic GCT may represent some evolving process to epithelial differentiated neoplasms (via somatic transformation) namely yolk sac tumor and teratoma along the germ cell differentiation chain. Therefore, SALL4 staining becomes a necessary step to avoid the pitfall of misdiagnosing unusual metastatic tumors with a known and unknown history of GCT particularly in male patients.

7850 Developmental ZNHIT3 expression in mice embryos in Mayer-Rokitansky-Küster-Hauser (MRKH) Syndrome related organs

Abstract Disclosure: D. Kira: None. B. Eroglu, MS, PhD: None. Z. Hawkins: None. L.P. Chorich: None. S. Brakta: None. L.C. Layman: None. Introduction: MRKH is a severe form of the Mullerian duct (MD) anomaly where the upper 2/3 of the vagina and the uterus fail to develop. Individuals with MRKH still have normally functioning ovaries and normal chromosomes. MRKH may be isolated Mullerian aplasia (type 1) or associated with renal, skeletal, cardiac, and/or auditory dysfunction (type 2). The etiology of MRKH syndrome remains unknown for most probands, although a genetic contribution is likely. Most evidence suggests autosomal dominant inheritance with incomplete penetrance. WNT4 and HNF1B pathogenic variants have been identified in some MRKH individuals. Recently, our lab identified heterozygous (HTZ) ZNHIT3 loss of function variants in persons with MRKH, Both variants predict functional changes in the ZNHIT3 C-terminus and impair protein expression in vitro. Previously, other investigators found biallelic variants in the N-terminus of ZNHIT3 in individuals with PEHO syndrome, a severe autosomal recessive neurodevelopmental disorder characterized by extreme cerebellar atrophy. We are currently characterizing a novel Znhit3 knockout (KO) mouse model, in which homozygous KO mice exhibit embryonic lethality. We have demonstrated ZNHIT3 RNA expression in the human uterus, heart, kidney, and skeleton, but developmental expression of ZNHIT3 in wild type (WT) animals has not been studied. In the WT mouse embryo, the kidney forms between E8.0 and E11, while the MDs form through invagination of epithelium ∼E11.5 and extend along the Wolffian duct until reaching the cloaca at ∼E13.5. Hypothesis: We hypothesize that ZNHIT3 is involved in MD development and expressed in the urogenital system and MRKH-related organs during embryonic development of WT mice. Method: Timed mating of WT mice produced embryos for analysis. Embryos were dissected out at E11.5, 12.5 and 13.5, fixed in 4% PFA, embedded in paraffin, and sectioned sagittally at 5mm thickness. H&E staining was done to identify sections showing kidney, genital tubercle, skeleton and cerebellum. Immunohistochemistry was also done using a ZNHIT3 antirabbit antibody and DAPI as nuclear counter stain. Imaging was performed using the Keyence fluorescence microscope (BZ-X800) at 10x and 40x magnification. Results: At all 3 time points, ZNHIT3 protein expression was observed in the developing urogenital organs including kidneys and bipotential gonads, as well as in vertebral bones and cerebellum. Heart protein expression studies are ongoing. Conclusion: ZNHIT3 protein expression is seen as early as E11.5 and is present in MRKH-related organs, suggesting it may play a role in the development of urogenital and MRKH-related organs. These findings provide the basis to compare expression in the Znhit3 KO mouse, a mouse model for MRKH. Presentation: 6/2/2024

CFTR Exon 10 deleterious mutations in patients with congenital bilateral absence of vas deferens in a cohort of Pakistani patients.

Congenital bilateral absence of vas deferens (CBAVD) is a urological syndrome of Wolffian ducts and is responsible for male infertility and obstructive azoospermia. This study is designed to explore the integrity of exon 10 of CFTR and its role in male infertility in a cohort of CBVAD patients in Pakistan. Genomic DNA was extracted from 17 male patients with CBAVD having clinical symptoms, and 10 healthy controls via phenol-chloroform method. Exon 10 of the CFTR gene was amplified, using PCR with specific primers and DNA screening was done by Sanger sequencing. Sequencing results were analyzed using freeware Serial Cloner, SnapGene, BioEdit and FinchTV. Furthermore, bioinformatics tools were used to analyze the mutations and their impact on the protein function and stability. We have identified 4 mutations on exon 10 of CFTR in 6 out of 17 patients. Two of the mutations were missense variants V456A, K464E, and the other two were silent mutations G437G, S431S. The identified variant V456A was present in 4 of the studied patients. Whereas, the presence of K464E in our patients further weighs on the crucial importance for its strategic location to influence the gene function at post-transcriptional and protein level. Furthermore, Polyphen-2 and SIFT analyze the mutations as harmful and deleterious. The recurrence of V456A and tactically conserved locality of K464E are evidence of their potential role in CBAVD patients and in male infertility. The data can contribute in developing genetic testing and treatment of CBAVD.

EZH2 specifically regulates ISL1 during embryonic urinary tract formation

Isl1 has been described as an embryonic master control gene expressed in the pericloacal mesenchyme. Deletion of Isl1 from the genital mesenchyme in mice leads to an ectopic urethral opening and epispadias-like phenotype. Using genome wide association methods, we identified ISL1 as the key susceptibility gene for classic bladder exstrophy (CBE), comprising epispadias and exstrophy of the urinary bladder. The most significant marker (rs6874700) identified in our recent GWAS meta-analysis achieved a p value of 1.48 × 10− 24 within the ISL1 region. In silico analysis of rs6874700 and all other genome-wide significant markers in Linkage Disequilibrium (LD) with rs6874700 (D’ = 1.0; R2 > 0.90) revealed marker rs2303751 (p value 8.12 × 10− 20) as the marker with the highest regulatory effect predicted. Here, we describe a novel 1.2 kb intragenic promoter residing between 6.2 and 7.4 kb downstream of the ISL1 transcription starting site, which is located in the reverse DNA strand and harbors a binding site for EZH2 at the exact region of marker rs2303751. We show, that EZH2 silencing in HEK cells reduces ISL1 expression. We show that ezh2−/− knockout (KO) zebrafish larvae display tissues specificity of ISL1 regulation with reduced expression of Isl1 in the pronephric region of zebrafish larvae. In addition, a shorter and malformed nephric duct is observed in ezh2−/− ko zebrafish Tg(wt1ß:eGFP) reporter lines. Our study shows, that Ezh2 is a key regulator of Isl1 during urinary tract formation and suggests tissue specific ISL1 dysregulation as an underlying mechanism for CBE formation.

Expression of Autophagy Markers LC3B, LAMP2A, and GRP78 in the Human Kidney during Embryonic, Early Fetal, and Postnatal Development and Their Significance in Diabetic Kidney Disease.

Autophagy is the primary intracellular degradation system, and it plays an important role in many biological and pathological processes. Studies of autophagy involvement in developmental processes are important for understanding various processes. Among them are fibrosis, degenerative diseases, cancer development, and metastasis formation. Diabetic kidney disease is one of the main causes of chronic kidney disease and end-stage renal failure. The aim of this study was to investigate the immunohistochemical expression patterns of LC3B, LAMP2A, and GRP78 during different developmental stages of early-developing human kidneys and in samples from patients with type II diabetes mellitus. During the 7/8th DW, moderate expression of LC3B and LAMP2A and strong expression of GRP78 were found in the mesonephric glomeruli and tubules. In the 9/10th DW, the expression of LC3B and LAMP2A was even more pronounced in the mesonephric tubules. LC3B, LAMP2A, and GRP78 immunoreactivity was also found in the paramesonephric and mesonephric ducts and was stronger in the 9/10th DW compared with the 7/8th DW. In addition, the expression of LC3B, LAMP2A, and GRP78 also appeared in the mesenchyme surrounding the paramesonephric duct in the 9/10th DW. In the 15/16th DW, the expression of LC3B in the glomeruli was weak, that of LAMP2A was moderate, and that of GRP78 was strong. In the tubuli, the expression of LC3B was moderate, while the expression of LAMP2A and GRP78 was strong. The strongest expression of LC3B, LAMP2A, and GRP78 was observed in the renal medullary structures, including developing blood vessels. In postnatal human kidneys, the most extensive LC3B, LAMP2A, and GRP78 expression in the cortex was found in the epithelium of the proximal convoluted tubules, with weak to moderate expression in the glomeruli. The medullary expression of LC3B was weak, but the expression of LAMP2A and GRP78 was the strongest in the medullary tubular structures. Significantly lower expression of LC3B was found in the glomeruli of the diabetic patients in comparison with the nondiabetic patients, but there was no difference in the expression of LC3B in the tubule-interstitial compartment. The expression of LAMP2A was significantly higher in the tubule-interstitial compartments of the diabetic patients in comparison with the nondiabetic patients, while its expression did not differ in the glomeruli. Extensive expression of GRP78 was found in the glomeruli and the tubule-interstitial compartments, but there was no difference in the expression between the two groups of patients. These data give us new information about the expression of LC3B, LAMP2A, and GRP78 during embryonic, fetal, and early postnatal development. The spatiotemporal expression of LC3B, LAMP2A, and GRP78 indicates the important role of autophagy during the early stages of renal development. In addition, our data suggest a disturbance in autophagy processes in the glomeruli and tubuli of diabetic kidneys as an important factor in the pathogenesis of diabetic kidney disease.

Epididymal mRNA expression profiles for the protein disulfide isomerase gene family: Modulation by development and androgens.

The endoplasmic reticulum (ER) is the central hub for protein quality control, where the protein disulfide isomerases (PDIs), encoded by at least 21 genes, play a pivotal role. These multifunctional proteins contribute to disulfide bond formation, proper folding, and protein modifications, and may act as hormone-binding proteins (e.g., steroids), influencing hormone biology. The interplay between ER proteostasis, PDIs, and epididymis-a crucial site for sperm maturation-remains largely understudied. This study characterizes transcriptional signatures of Pdi genes in the epididymis. Transcriptional profiles of selected Pdi genes were assessed in adult Wistar rat tissues, and epididymis under different experimental conditions (developmental stages, surgical castration, and efferent ductules ligation [EDL]). In silico bioinformatic analyses identified expression trends of this gene family in human epididymal segments. P4hb, Pdia3, Pdia5, Pdia6, Erp44, Erp29, and Casq1 transcripts were detected in both reproductive and non-reproductive tissues, while Casq2 exhibited higher abundance in vas deferens, prostate, and heart. Pdilt, highly expressed in testis, and Pdia2, highly expressed in heart, showed minimal mRNA levels in the epididymis. In the mesonephric duct, epididymal embryonic precursor, P4hb, Pdia3, Pdia5, Pdia6, and Erp29 mRNAs were found at gestational day (GD) 17.5. Except for Erp29, which remained stable, these Pdi transcript levels increased from GD17.5 to GD20.5, when epididymal morphogenesis occurs, and were maintained to varying degrees in the epididymis during postnatal development. Surgical castration downregulated P4hb, Pdia3, Pdia5, Pdia6, Pdilt and Erp29 transcripts, an effect reversed by testosterone replacement. Conversely, transcript levels remained unaffected by EDL, except P4hb, which was reduced in caput epididymis. All 21 PDI genes exhibited diverse transcriptional profiles across the human epididymis. The findings lay the foundations to explore Pdi genes in epididymal biology. As a considerable proportion of male infertility cases are idiopathic, targeting hormonal regulation of protein quality control in epididymis represents a route to address male infertility and advance therapeutic interventions in this domain.

Polymorphic CAG and GGN repeats in Cryptorchidism patient risk: A meta-analytical study

Genetic mutations in the androgen receptor (AR) gene have been identified as the cause of androgen insensitivity syndrome. These mutations are linked to inconsistent development of the Wolffian duct and may result in conditions such as micropenis, hypospadias, and cryptorchidism. The androgen receptor has two polymorphic sites located in exon 1, which consists of varying amounts of CAG and GGN repeats. These repetitions lead to the formation of polyglutamine and polyglycine stretches of varied lengths. Increased CAG repeats lead to a decrease in androgen receptor transcriptional activity, but the impact of GGN triplets is less well understood. This research examined the CAG and GGN repeat lengths in males who had a past medical record of cryptorchidism. Prospective and retrospective observational studies from PubMed, Science Direct, and Embase were systematically searched up to 15th November 2020. Primary outcomes were analyzed using a fixed or random effect model regarding its heterogeneity and continued with multilevel modeling of each polymorphism and ethnicity. CAG and GGN repeat polymorphism was found to be significantly different compared to control in contributing to cryptorchidism (CAG: 0.55 [CI 95%=0.19-0.91]; p-value=0.003 and GGN 0.90 [CI95%=0.65-1.15]; p value<0.000). In conclusion, CAG and GGN repeat polymorphism have an essential role in the incidence of cryptorchidism.

Biomechanical properties of the capsule and extracellular matrix play a major role during the Wolffian/epididymal duct development.

The epididymis is important for sperm maturation and without its proper development, male infertility will result. Biomechanical properties of tissues/organs play key roles during their morphogenesis, including the Wolffian duct. It is hypothesized that structural/bulk stiffness of the capsule and mesenchyme/extracellular matrix that surround the duct is a major biomechanical property that regulates Wolffian duct morphogenesis. These data will provide key information as to the mechanisms that regulate the development of this important organ. To measure the structural/bulk stiffness in Pascals (force/area) of the capsule and the capsule and mesenchyme together that surrounds the Wolffian duct during the development. To examine the relative membrane tension of mesenchymal cells during the Wolffian duct development. Since Ptk7 was previously shown to regulate ECM integrity and Wolffian duct elongation and coiling, the hypothesis that Ptk7 regulates structural/bulk stiffness and mesenchymal cell membrane tension was tested. Atomic force microscopy and a microsquisher compression apparatus were used to measure the structural stiffness. Biomechanical properties within the membranes of cells within the capsule and mesenchyme were examined using a membrane-tension fluorescent probe. The structural stiffness (Pascals) of the capsule and underlying mesenchyme was relatively constant during development, with a significant increase in the capsule at the later stages. However, this increase may reflect the ECM and associated mesenchyme being close to the capsule because the coiling of the duct pushed or compressed them into that space. Keeping the capsule and mesenchyme/ECM at constant stiffness would ensure that the duct will continue to coil under similar biomechanical forces throughout the development. Cells within the capsule and mesenchyme at different Wolffian duct regions during the development had varying degrees of membrane lipid tension. It is hypothesized that the dynamic changes ensure the duct is kept at a constant stiffness regardless of any external forces. Loss of Ptk7 resulted in an increase in stiffness at E18.5, which was presumable due to the loss of integrity of the ECM within the mesenchyme. Biomechanical properties of the capsule and the mesenchyme/extracellular matrix that surround the Wolffian duct play an important role toward Wolffian duct morphogenesis, thereby allowing for the proper development of the epididymis and subsequent male fertility.

Zinner syndrome: a radiological journey through a little known condition.

Zinner syndrome is a rare congenital urological entity, secondary to an alteration in embryogenesis between 4th and 13th weeks of gestation, specifically because of abnormalities in the development of the distal mesonephric duct. It is characterized by the triad of unilateral renal agenesis, cystic dilatation of the ipsilateral seminal vesicle and ipsilateral ejaculatory duct obstruction. The aim of this article is to provide the reader with all the necessary information to be able to suspect the presence of this syndrome, reviewing its physiopathology, clinical manifestations and the imaging techniques that enable its diagnosis, emphasizing those radiological findings by MRI that should lead us to think about it. This work is illustrated with representative radiological images of cases belonging to our institution, including patients with different variants of Zinner syndrome. We also include an overview of the embryology of the male urogenital system, to remember the role of the mesonephric duct and the ureteral bud in the formation of the different urogenital structures, as well as a differential diagnosis that allows us to differentiate seminal vesicle cysts from other pelvic cystic lesions.

Zinner syndrome in pediatric age group: An underdiagnosed entity

Zinner Syndrome (ZS), a rare congenital malformation of the mesonephric duct, combines seminal vesicle cyst (SVC) with ipsilateral upper urinary tract abnormalities. Typically asymptomatic in childhood, ZS manifests between 2nd to 4th decades with bladder symptoms, perineal pain and infertility. Diagnostic confirmation with additional imaging is needed when either renal or seminal abnormalities are identified. A retrospective study spanning 22 years identified 20 pediatric ZS cases through clinical analytics. Demographic, clinical, and radiological data were analyzed, including presenting complaints, imaging modalities (ultrasound, CT, MRI), and surgical findings. The study was HIPAA-compliant and IRB-approved. Among 20 cases (mean age: 7.3 years), clinical presentations included asymptomatic cases, urinary symptoms, and abdominal pain. Imaging revealed renal anomalies (agenesis, multicystic dysplastic kidney) and seminal vesicle abnormalities. Surgical interventions (n=12) addressed symptomatic cases, often involving robotic or laparoscopic procedures. ZS, though rare, presents with varied clinical features, necessitating a multidisciplinary approach. Early diagnosis is facilitated by prenatal identification of renal abnormalities. Surgical intervention is reserved for symptomatic cases, with techniques such as vesiculectomy and resection of remnant structures employed. This study highlights ZS's diverse clinical and radiological spectrum, emphasizing the need for vigilance in detecting overlapping entities. Timely identification, utilizing advanced imaging techniques, is crucial for accurate diagnosis and appropriate management of Zinner Syndrome in the pediatric population.

Valve of the Posterior Urethra in Girls: A Case Report from the Gavardo Hospital in Mali

This is a prospective study of a single case of posterior urethral valve in a 2-year-old girl in the Gabriel Toure Urology Department. Posterior urethral valves (PUV) are congenital obstructive membranous folds that represent the main cause of congenital subvesical obstruction and dysuria in children and infants [1]. Their aetiology remains unknown, and is probably related to poor positioning of the orifices of the Wolffian ducts leading into the urethra [2]. Abdominal and pelvic ultrasound combined with Uroscanner revealed bilateral ureterohydronephrosis with repercussions on the upper urinary tract. Suprapubic cystography showed stenosis of the membranous urethra with dilatation of the posterior urethra upstream of the valve and diverticular bladder. The procedure consisted of ureterovesical reimplantation plus intubation via an external ureteral drain, which was removed at10 postoperatively, and stripping followed by ureterovesical catheterisation. The post-operative course was straightforward.

Zinner syndrome in a case of male infertility: a case report

Zinner syndrome is a rare congenital malformation formed by the developmental anomaly of distal portion of the wolffian duct. It is an unusual cause of infertility and dysuria among young males. It is associated with ipsilateral renal agenesis, seminal vesical cyst, and ejaculatory duct obstruction. We herein report a rare case of a Zinner syndrome, in a patient of primary infertility. He also presented with complaints of chronic pelvic pain and dysuria. Any young patients of male infertility or unspecified pelvic complaints should be evaluated for Zinner syndrome and surgical intervention is the mainstay treatment for symptomatic patients.

Gestational diabetes mellitus induces congenital anomalies of the kidney and urinary tract in mice by altering RET/MAPK/ERK pathway

Gestational diabetes mellitus (GDM) presents a substantial population health concern. Previous studies have revealed that GDM can ultimately influence nephron endowment. In this study, we established a GDM mouse model to investigate the embryological alterations and molecular mechanisms underlying the development of congenital anomalies of the kidney and urinary tract (CAKUT) affected by GDM. Our study highlights that GDM could contribute to the manifestation of CAKUT, with prevalent phenotypes characterized by isolated hydronephrosis and duplex kidney complicated with hydronephrosis in mice. Ectopic ureteric buds (UBs) and extended length of common nephric ducts (CNDs) were noted in the metanephric development stage. The expression of Ret and downstream p-ERK activity were enhanced in UBs, which indicated the alteration of RET/MAPK/ERK pathway may be one of the mechanisms contributing to the increased occurrence of CAKUT associated with GDM.

Morphogenetic Promoters in the Development of Provisional and Definitive Urinary Organs in Humans and Vertebrates

The aim is to show the regulatory significance of promoter organs of morphogenesis in a stable state of the kidneys of vertebrates (fish, birds) and humans. Material and methods. 118 embryos at stages 12-23 of Carnegie (SC) and 28 human fetuses of 9-12 weeks of fetogenesis, 268 embryos of meat chickens (cross "Hibro PG +") from the stage of 48 hours to 20 days of broiler egg incubation, 50 fry of peled Coregonus peled were studied (Gmelin, 1788) at the stage of yolk sac atrophy (stage 36-37 according to the classification of Detlaf, 1975). To study the method of light microscopy, the material fixed in a 10% neutral form, embedded in paraffin. Sections stained with Mayer's hematoxylin and eosin, McManus CHIC method. Ki-67, CD31, CD34, positive cells are detected by immunohistochemistry. Primary kidney examination by low-vacuum electron microscopy. Embryos and human fetuses are observed in the Tyumen health care facility during medical abortion on demand in anamnestic healthy women with their warning about emergency work. Observation chicken embryos at the poultry farm “Tyumensky Broiler”, incubation workshop (Kaskara village, Tyumen region). Morphometric analysis and statistical processing of the actual material were carried out. Results. It was shown that the organotypic differentiation of the intermediate mesenchyme and the formation of nephrons of the provisional and definitive urinary organs control the state of the mesonephric duct and metanephritic diverticulum. The mesonephric duct initiates the organotypic antibiotic of the perifocal intermediate mesonephric mesenchyme and detects the proximodistal vector of saltatory mesonephronogenesis. The metanephritic diverticulum and its daughter branches initiate the organotypic differentiation of the intermediate mesenchyme and control the fan mechanism of metanephronogenesis. Activity of nephronogenesis Determination of the dynamics of convergence of immunocompetent cells. The absence of ventrodorsal generation of mesonephrons in humans is associated with a significant vital cycle of a normal kidney, atrophy of the mesonephric duct, and a decrease in the activity of immunocompetent cells. An increase in the expression of CD31, CD34, Bcl-2, Ki-67 positive cells is realized in combination with the formation of nephron rudiments as the promoter organs move in the developing organ of urinary formation. Conclusion. Prenatal organogenesis monitors and constantly monitors the formation of promoter organs of morphogenesis - the mesonephric duct and the metanephric disserticulum. Organotypic infection of the intermediate mesenchyme during the development of fish, birds and humans correlates with the chronovector of the convergence of immunocompetent cells.

Zinner syndrome: A rarer variant of a rare syndrome

Zinner syndrome, characterized by the combination of absent unilateral kidney, obstructed ejaculatory duct on the same side, and cysts in the seminal vesicle, represents a rare congenital malformation of the mesonephric duct. Its symptoms are often vague, ranging from urinary discomfort to painful ejaculation and infertility, making it difficult to diagnose without imaging. In this report, we discuss a less common form of Zinner syndrome identified through diagnostic imaging.

Robotic excision of a giant seminal vesicle cyst

Abstract Zinner syndrome is a rare congenital condition characterized by unilateral renal agenesis, ejaculatory duct obstruction, and seminal vesicle cyst. This syndrome is caused by an embryonic malformation of the mesonephric or Wolffian duct. Seminal vesicle cysts are commonly reported, and men with these cysts often present with infertility. This report presents a case of a giant seminal vesicle cyst that was incidentally found while evaluating for bowel symptoms. The seminal vesicle cyst was successfully managed by robot-assisted excision.

Incidental Zinner Syndrome in Nigeria: A Case Report

Zinner syndrome (ZS) is a rare urogenital condition characterised by the triad of unilateral renal agenesis, ipsilateral seminal vesicle cyst, and ipsilateral ejaculatory duct obstruction, resulting from malformation during early embryogenesis of the mesonephric (Wolffian) duct. The authors present a 35-year-old male who was being evaluated for chronic hepatitis B virus infection. He was referred to the urology outpatient clinic on account of incidental ultrasound finding of solitary right kidney. General physical examination revealed a healthy-looking young male with a flat abdomen and no palpable enlarged organs. Digital rectal examination revealed normal sized prostate with no palpable pararectal masses. MRI of the pelvis revealed a triad of unilateral renal agenesis, ipsilateral seminal vesicle cyst, and ipsilateral ejaculatory duct obstruction. The clinical diagnosis was asymptomatic ZS. He is on yearly follow-up at the urology outpatient clinic for lower urinary tract symptoms, pelvic pain, painful ejaculation, features of infertility, and pelvic ultrasound. If any of these symptoms occur, he will be treated with an α-adrenergic receptor blocker, drainage of the seminal vesicle cyst, and appropriate treatment for infertility. He is also on active surveillance for viral hepatitis by the gastroenterology team. In conclusion, prompt referral and comprehensive radiological imaging investigations of patients with unilateral agenesis of the kidney will lead to increased identification and report of patients with ZS. There is paucity of literature reports on ZS in the authors’ environment, and this case report, to the best of the authors’ knowledge, is the first from Nigeria.