Zinner’s syndrome: an up-to-date review of the literature based on a clinical case

Abstract

The authors made an up-to-date review of the literature concerning the management of Zinner's syndrome and evaluated a young patient with Zinner's syndrome who had presented with urinary and ejaculatory complaints. Physical examination and transrectal ultra-sonography showed a 7.0 cm right seminal vesicle cyst. Magnetic resonance imaging (MRI) confirmed the diagnosis of Zinner's syndrome. Oligoasthenoteratozoospermia was present at the two seminal analyses. Symptomatic improvement was achieved with conservative measures. Actually, the patient is still on a follow-up programme. The diagnosis is usually established at the age of increased sexual activity. Patients may be asymptomatic or present pain, irritative urinary or ejaculatory symptoms and infertility. MRI has proved to be the best imaging examination. Treatment should be adapted to symptoms, surveillance being the best option in the absence of clinical manifestations. Surgical approach may be adequate when conservative measures prove ineffective. Zinner's syndrome should be suspected if a male young patient presents with unilateral renal agenesis and pelvic complaints and has a supraprostatic mass on digital rectal examination. The initial approach should be medical, but invasive procedures may be the only way to solve the patient's complaints. Nowadays, laparoscopic and robotic techniques must replace the open surgical approach.

Asymptomatic Zinner's Syndrome Diagnosed during the Sixth Decade of Life: Case Report and Review of the Literature

“…Zinner's syndrome is an unusual congenital malformation, first described in 1914 by Zinner, characterised by renal agenesis associated with ipsilateral seminal vesicle cysts and obstruction of the ejaculatory duct [1] . Less than 250 cases are reported in the literature [1] .…”

“…Less than 250 cases are reported in the literature [1] . This malformative association is explained by the common embryogenetic origin of the involved organs (mesonephric Wolffian duct) [2] .…”

Male Genitourinary System

“…The congenital form is associated with ipsilateral renal agenesis in as many as 80% of cases, although this entity has been described in less than 100 case reports (Cherullo et al 2002;Kuo et al 2011). As this entity is often asymptomatic, it is thought that the increasing use of CT and MRI has also increased the detection of these cysts (Pereira et al 2009). …”

“…Cysts have high-intensity signal on T1-weighted images (Murphy et al 2003;Pereira et al 2009). Vasovesiculography is the gold standard, but rarely used except intraoperatively due to its invasiveness (Cherullo et al 2002;Kuo et al 2011).…”

It’s not always varicocele: A strange case of Zinner syndrome

“…Treatment usually includes seminal way disclosure via transurethral resection of the ejaculatory duct and open, laparoscopic or robotic vesiculectomy. 3 Transrectal or transperineal aspiration is another option to relieve symptoms and to establish the diagnosis by allowing instillation of contrast material, 7 but simple cyst drainage is associated with the risk of recurrence, the return of symptoms, and possible infection. Open excision requires extensive dissection due to the deep location of seminal vesicles, and is associated with a high rate of morbidity.…”