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

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.

A rare case of abdominal pain

“…The ZS description comprises the seminal vesicle cyst with ipsilateral renal agenesis and obstruction of the ejaculatory duct with an ectopic ureter 7 , 8. According to Maehana et al,9 to date, just over 200 cases of ZS have been described. It is considered the male counterpart of the Mayer-Rokitansky-Kuster-Hauser syndrome of females.…”

“…The symptomatic cases are characterized by perineal pain, painful ejaculation, lower urinary tract symptoms, and other urinary symptoms 9 , 12. Van den Ouden et al13 described dysuria (37%), urinary frequency (33%), perineal pain (29%), epididymitis (27%), and pain after ejaculation (21%) as the main complaints in a series of 52 patients with the diagnosis of ZS.…”

“…Abdominal pain is a rare symptom of ZS. When present in the suprapubic or lower quadrant, it can be explained by ureterocele or seminal vesicle cyst growth, which elicits an inflammatory reaction in the surrounding viscera 9…”

“…In an asymptomatic patient, the treatment can be conservative with follow-up. For symptomatic patients or cysts greater than 50 mm, the best approach is laparoscopic (as proposed to our patient) or robotic techniques, with surgical excision of the seminal vesicle cysts 9 , 12 , 17. These techniques can relieve the symptoms while preserving fertility and erectile function 17 , 18…”

Long-Term Surveillance and Laparoscopic Management of Zinner Syndrome

“…There are reports of open, laparoscopic, and robotically assisted excision of the cysts [4,5], and the patients have all experienced a resolution of their symptoms after treatment. Aspiration of symptomatic cysts, however, tends to lead to recurrence of the symptoms, ultimately requiring surgical excision at a later date [6][7][8]. In patients where infertility was the presenting complaint, transurethral resection of the ejaculatory ducts was attempted [9], with subsequent improvement in semen characteristics.…”