Emergency surgery in octogenarians is a significant part of the workload of general surgeons. Poor baseline status is associated with an increased risk of mortality. Emergency surgery in older adults only utilizes a fraction of available intensive care unit resources. Geriatr Gerontol Int 2018; 18: 1211-1214.
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.
Background: Preclinical and clinical research is largely inclusive of both the female and the male
population, but the lack of specific separation of data according to patient sex prevents the detection of the
impact of sex on cancer biology and response to medications and treatment. This study aimed to examine
the consideration of sex as a biological variable in preclinical and clinical studies in kidney cancer.
Methods: Preclinical and clinical studies pertaining to kidney cancer published in three leading urology
journals over a two-year period were reviewed for the reporting of cells, animal or patient sex, and the
inclusion of sex as a biological variable in both study design and data analysis.
Results: 171 clinical studies and 5 preclinical studies were included. While the sex of the participants was
disclosed in all but 10 of the 171 clinical studies reviewed, the patient populations were largely maledominated (male to female ratio > 1.5). Only 5 studies contained more female than male patients. Sexspecific reporting was performed in 3% of studies, and only 37% included sex as part of the statistical
analysis. 26% of these identified a statistically significant difference in measured outcomes between male
and female participants.
Conclusion: Kidney cancer research is sex-inclusive, but the female patient population remains
underrepresented. The consideration of sex in data analysis is low and could prevent the identification of
key sex-specific optimization opportunities for the improved management of the disease.
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