Samenblasenzysten bei ipsilateraler Nierenagenesie

Abstract

Congenital seminal vesicle cysts associated with ipsilateral renal agenesis or dysplasia are rare malformations. Even though they are more often diagnosed today due to the introduction of advanced, sectional imaging techniques as CT and MRI, no reliable data about the prevalence of this malformation are available. This study reports seven consecutive cases, with long-term follow-up in five cases (26-119 months, mean 52 months). All patients underwent sonography, excretory urography, CT and MRI. Only two of seven patients presented nonspecific symptoms of the lower urinary tract; five were asymptomatic. In all cases sonography revealed the cystic character of the retrovesical enlargement. The anatomy of the lower pelvis was most accurately shown on MRI, which depicted the ectopic insertion of the ureter into the seminal vesicle in five cases. Cysts demonstrated high signal intensities in T1- and T2-weighted spin-echo images. In five cases the CT density was over 40 HU. Whereas one patient (15 years) presented significant enlargement of the cysts 10 years after primary diagnosis with compression of the urinary bladder, four patients showed no changes of their malformation in the follow-up examinations. The present data therefore support the concept of treating only symptomatic patients.

Screening for Zinner Syndrome in Patients With a Congenitally Solitary Kidney: Lessons Learned

“…Complete urodynamic studies were performed per AUA guidelines, 11-13 with nomograms defining obstruction, equivocal for obstruction, or an underactive detrusor as per standardized detrusor pressure uroflow nomograms (see Figure 2). …”

“…Abbreviations: CIC, clean intermittent catheterization; FSH, follicle-stimulating hormone; LH, luteinizing hormone; LUTS, lower urinary tract symptoms; NA, not applicable; PVR, postvoid residual urine; TUR-ED, transurethral resection of the ejaculatory duct; UDS, urodynamic study; US, ultrasound; UTI, urinary tract infection.Normal uroflow is defined as bell-shaped curve pattern, peak ≥15 mL/s, PVR <70 mL, with >150 mL voided.Complete urodynamic studies were performed as per AUA guidelines, 11-13 with nomograms defining obstruction, equivocal for obstruction, or an underactive detrusor as per the Abrams-Griffiths nomogram (Figure 2). Successful treatment with alpha blockers is a decrease of ≥3 points from the pretreatment AUA Symptom Score.Normal semen values: volume 1.5-5 mL, pH 7.2-7.8, sperm concentration >15 million/mL, progressive motility >32%, sperm morphology >4%, leukocytes <1 million/mL white blood cells, fructose >150 mg/dL.…”

“…Our reluctance to intervene was due to concerns that operative procedures on complex cystic structures deep in the pelvis could cause damage to the contralateral ejaculatory duct or pelvic nerves, possibly resulting in infertility, erectile dysfunction, or voiding difficulties. 6,7,11,12 After evaluating our data, we believe our decision not to operate until symptoms developed may have been an error. Specifically, surgical interventions were rarely associated with postoperative complications.…”

“…Regarding infertility with Zinner syndrome, prior studies revealed 15% of patients initially presented with complaints of primary infertility, with 45% Normal uroflow is defined as bell-shaped curve pattern, peak !15 mL/s, PVR <70 mL, with >150 mL voided. Complete urodynamic studies were performed per AUA guidelines, [11][12][13] with nomograms defining obstruction, equivocal for obstruction, or an underactive detrusor as per standardized detrusor pressure uroflow nomograms (see Figure 2). Successful treatment with alpha blockers is a decrease of !3 points from the pretreatment AUA Symptom Score.…”

“…Complete urodynamic studies were performed as per AUA guidelines, [11][12][13] with nomograms defining obstruction, equivocal for obstruction, or an underactive detrusor as per the Abrams-Griffiths nomogram (Figure 2). Successful treatment with alpha blockers is a decrease of !3 points from the pretreatment AUA Symptom Score.…”