Zinner’s Syndrome: A Rare Diagnosis of Dysuria Based on Imaging

Abstract

Zinner’s syndrome is a rare congenital malformation of the seminal vesicle and ipsilateral upper urinary tract, due to developmental arrest in early embryogenesis of the Müllerian duct. Clinical presentation is nonspecific and includes voiding symptoms such as dysuria, ejaculatory disorders, and hypogastric or perineal pain. The diagnosis is made with imaging techniques, notably Magnetic Resonance Imaging (MRI) which remains the gold standard exam for diagnosis confirmation and therapeutic management. Treatment options depend on the severity of symptoms, the size of the cyst, and the complications. Herein, we report a rare case of a 33-year-old young patient who presented recurrent dysuria and ejaculatory disorders for the last 5 years. Imaging studies revealed an empty left renal fossa, with cystic pelvic mass related to the seminal vesicle and which was compatible with the diagnosis of Zinner’s syndrome. The patient underwent successful laparoscopic removal of the cyst and seminal vesicle, with total disappearance of urinary and sexual complaints with a 3-year follow-up.

Role of magnetic resonance imaging in evaluation of ejaculatory duct in Zinner’s syndrome: case series of five patients and review of the literature

“…It is considered the modality of choice for the accurate anatomical demonstration of the male genital tract and hence confirming the periprostatic cystic lesion whether originating from seminal vesicle or not [15]. On MRI the seminal vesicle cyst appears hypointense on T1 and hyperintense on T2 weighted images; high protein cyst being exception which would have high signal on T1 weighted and intermediate to low signal on T2 weighted images [18], Intracystic vegetation's can be a sign of malignancy, although malignant degeneration remains exceptional with only 3 reported cases in the literature [6]. Seminal vesicle cyst needs to be differentiated from ejaculatory duct cyst, ureterocele and urinary bladder diverticulum.…”

“…Till now few hundreds only of cases reported in the literature [5], mainly clinical presentation is nonspecific, resulting in delayed or missed diagnosis, most of patients remain asymptomatic until starting sexual activity. Although different radiological modalities play main role in the diagnosis, Magnetic resonance imaging (MRI) is the superior Page 2 of 12 Elsorougy et al Egypt J Radiol Nucl Med (2022) 53:225 modality in the diagnostic arsenal in making conclusive diagnosis [6]. Although using an endorectal coil (ERC) in patients with suspected obstructive infertility is a valuable method to evaluate the lower male genital tract.…”

Si?ndrome de Zinner: um relato de caso / Zinner syndrome: a case report

“…al) 19 O desafio dos diferentes tratamentos é preservar a fertilidade do paciente e aliviar os seus sintomas (IBRAHIMI, et. al) 3 Devido aos riscos envolvidos em abordar de forma cirúrgica uma área delicada, opta-se por intervir somente naqueles pacientes que apresentam sintomas. A cirurgia está associada a diversas complicações devido à localização profunda da vesícula seminal e à necessidade de dissecar os cistos no espaço retrovesical.…”

Magnetic resonance urography of congenital abnormalities — what the radiologist needs to know

“…12). It is rare, with only 200 cases reported in the available literature [30]. The ipsilateral ureter can be absent or incomplete [31][32][33].…”