Minimally Invasive Approach for Treatment of Seminal Vesicle Cyst Associated with Ipsilateral Renal Agenesis

Abstract

Objectives: We reviewed the clinical presentation and approach for the treatment of symptomatic seminal vesicle cyst associated with ipsilateral renal agenesis while presenting our experience with a series of 5 patients treated with minimally invasive surgery for Zinner syndrome. Materials and Methods: Between the years 2008 and 2016, we operated on 5 patients who presented with symptomatic seminal vesicle cyst and ipsilateral renal agenesis. Patients' charts and medical records were reviewed and compared with past published minimally invasive series. Results: Four patients were treated in a laparoscopic approach and one was treated with robotic-assisted seminal vesicle cyst excision. In all cases, the cystic complex was drained and excised with marsupialization of the remaining cyst walls to prevent cystic recurrence. The mean operating time was 3:47 h and mean hospitalization time was 7 days (4-14). The mean follow-up period was 3.2 years (range 1.7-4.8 years). All patients reported a resolution of symptoms during postoperative follow-up. Conclusions: Seminal vesicle cyst with ipsilateral renal agenesis should be suspected in young male patients presenting with pelvic cystic masses. Treatment is reserved for symptomatic patients and the preferred approach is minimally invasive surgery. This approach is feasible and effective while providing advantages both for the patient and the surgeon.

Classifying seminal vesicle cysts in the diagnosis and treatment of Zinner syndrome: A report of six cases and review of available literature

“…Calcification is best observed in noncontrast CT scans. Density: Cyst density is one of the determining factors in the classification of seminal vesicle lesions. In literature, it has been reported that the CT value of a cyst with liquid (water‐like) content is <20 HU (type I) and the CT value of a cyst with protein or haemorrhage content is higher than 30–40 HU (type II; Bosniak, ; Campora et al, ; Fiaschetti et al, ; Kenney & Leeson, ; Kord et al, ; Naval‐Baudin et al, ). Some studies have reported purulent compositions of cysts with CT values higher than 30–40 HU.…”

“…Infertility, haematuria, and haematospermia are some of the cases that may also bring a patient to medical attention. Due to its nonspecific signs and symptoms, Zinner syndrome may be missed or misdiagnosed (Campora et al, ; Fiaschetti et al, ; Kord et al, ; Slaoui et al, ). The objectives of the present study are to detail this syndrome's abnormal anatomy, define the role of noninvasive imaging in diagnosis and management, and propose a seminal vesicle cyst classification through imaging to help stratify its management.…”

Massive seminal vesicle cyst with ipsilateral renal agenesis – Zinner syndrome in a Saudi patient

“…Minimally invasive surgery involving laparoscopic or robotic assisted excision of the cyst appears to be the modality of choice for symptomatic patient and is associated with a favorable outcome and results in resolution of symptoms in the majority of the cases. [ 11 ]…”

Robotic-assisted laparoscopic vesiculectomy in a patient with atypical Zinner syndrome presenting with large cyst involving bilateral seminal vesicles and vasa deferentia

“… 2 Since then, minimally invasive approaches have become favored in treatment of seminal vesicle pathology due to better visualization of pelvic anatomy, shorter hospital stay, and faster patient recuperation. 3 The use of laparoscopy paved the way for robotic-assisted surgery, with comparable patient outcomes and heightened surgeon comfort. 4 Specifically, Passerotti et al showed that robotic resection of seminal vesicle cysts and prostatic utricles in children and adolescents yielded desirable outcomes.…”