Zinner综合征1例报道并文献复习

目的:探讨精囊囊肿伴同侧肾缺如(Zinner综合征)的临床诊断和治疗特点,提高对本病的认识。方法:回顾性总结我院1例Zinner综合征患者的诊断、治疗等临床资料。复习文献对Zinner综合征进行讨论。结果:患者23岁,经影像学检查确诊为Zinner综合征,入院后行经直肠精囊囊肿穿刺抽吸术,术后3 d出院。出院6个月后随访,患者排尿终末期会阴部不适症状消失,但经直肠前列腺彩超提示左侧精囊腺积液大小同前,考虑复发。结论:一侧精囊囊肿伴同侧肾缺如,需要考虑Zinner综合征的可能。经直肠精囊囊肿穿刺抽吸术明显缓解患者局部不适症状,但精囊囊肿容易复发,不推荐作为该病治疗的首选方法。     

Zinner综合征的诊断和微创治疗(附2例报告并文献复习)

目的:根据2例Zinner综合征患者的诊治过程,结合有关文献探讨其临床特征,诊断方法和微创治疗手术。方法:本院近年收治的2例Zinner综合征患者,1例行经腹腔镜精囊囊肿切除加输尿管残端切除术,另1例行经尿道精囊囊肿去顶减压术加精囊壁电灼术。根据该类患者的临床表现、诊断和治疗过程,结合相关文献对该病的临床特征和治疗后随访结果进行分析。结果:2例手术均顺利完成,平均手术时间95min,无膀胱、直肠等手术并发症,术后随访3~12个月,患者术前不适症状消失,无勃起及射精功能障碍。结论:一侧肾缺如合并同侧盆腔内占位,需要考虑Zinner综合征的可能,微创手术尿道精囊镜下囊肿去顶减压加内膜烧灼术是这类患者的理想选择方式。     

容易误诊的Zinner综合征一例报告

正Zinner综合征为一种罕见的先天性疾病,发病率不足0.005%,表现为先天性精囊囊肿合并同侧肾发育不全或肾缺如,一般情况下没有明显症状,许多患者在体检或者因为其他疾病就诊时发现,部分患者出现盆腔或会阴部疼痛不适等症状。如出现明显症状,则需要手术治疗。本文介绍在门诊发现的因高血压就诊开始被误诊为副神经节瘤的1例Zinner综合征,通过腹腔镜手术切除精囊囊肿解除疼痛症状,但是血压高仍需要药物控制。     

腹腔镜精囊囊肿切除术

目的:探讨腹腔镜下精囊囊肿切除术的方法及临床疗效。方法:我院近期采用腹腔镜技术对2例伴有临床症状的精囊囊肿患者实施精囊囊肿切除术。术前经超声及CT等检查明确诊断,精囊囊肿大小为3.3cm×3.7cm×2.5cm,4.1cm×4.3cm×5.3cm。结果:2例手术均顺利完成,手术时间为140、100min,术中出血约50、20ml,术后6d出院。分别随访6、7个月,患者术前症状消失,无并发症发生,复查超声,均未见囊肿复发。结论:腹腔镜下精囊囊肿切除术具有视野清晰、操作精细、创伤小、恢复快等优点,是一种安全、有效的微创手术方式。     

Zinner综合征3例报告及文献复习

目的 探讨Zinner综合征的临床特征、诊断、鉴别诊断及治疗方法。方法 回顾本院近年收治的3例Zinner综合征患者,根据该类患者的临床表现、诊治过程,结合文献对该病的临床特征和治疗后随访结果进行分析。结果 3例患者中2例为右侧病变,1例为左侧病变;3例均无射精障碍,2例为成年患者,已育。临床确诊后,1例排尿困难者行经腹腔镜下精囊囊肿去顶及输尿管残端切除术,1例合并精囊结石的无症状患者行精囊镜取石术,1例无症状患者仅采取随访观察。2例手术均顺利完成,无并发症。术后复查,影像学较术前改善,排尿困难的患者症状消失。结论 一侧肾缺如合并同侧盆腔囊性占位,需要考虑Zinner综合征的可能。应根据患者具体表现选择个体化治疗方法,对符合手术适应证的患者可采用腹腔镜手术或经尿道手术。     

经膀胱途径精囊肿块切除术(附5例报告)

目的:探讨经膀胱途径在精囊疾病外科治疗中的应用。方法:本组5例男性患者,年龄45～69岁,平均51岁。临床症状:3例主要表现为尿频、尿急、排尿不畅等下尿路症状,其中1例同时伴有排便不畅,大便变细。1例因血精就诊,1例因下腹部及会阴部隐痛不适,B超检查发现右侧精囊肿块入院。病程2～18个月,平均9个月。经直肠指检、直肠B超、盆腔CT及MRI等检查诊断为左侧精囊肿块2例,右侧3例,肿块长径3～10cm,平均5cm。5例均行经膀胱途径精囊肿块切除术。结果:5例手术均获得成功,平均手术时间75min,平均出血量140ml,术后平均住院时间10d。病理报告:精囊囊肿伴感染2例,精囊囊腺瘤1例,精囊低度恶性分叶状肿瘤1例,前列腺组织1例。随访时间3～72个月,术后症状消失或明显改善。复查B超及CT未见复发。结论:经膀胱途径精囊肿块切除术,手术切口小,视野清晰,操作简便,易于开展,是精囊疾病外科治疗的有效方法。     

Zinner综合征2例报告

正先天性精囊囊肿合并同侧肾发育不全或肾缺如临床罕见,ZINNER在1914年首次报道该病,故又称Zinner综合征[1]。临床常见症状为血精、血尿和射精障碍等,南京中医药大学附属中西医结合医院2012—2017年收治2例Zinner综合征患者,现报告如下。1病例报告例1,男性,25岁,因"下腹部胀痛半年"入院。曾外院行右隐睾切除术。查体:直肠指诊(digital rectal examination,DRE)前列腺右上方触及一囊性包块,     

腹腔镜手术切除精囊囊肿

精囊囊肿是一种罕见疾病,人群中发病率低于0．005％。有症状的精囊囊肿常需手术治疗,治疗方法有经直肠穿刺抽吸、经尿道内镜去顶减压或穿刺抽吸、经腹或经会阴囊肿切除。随着腹腔镜技术成熟,腹腔镜逐渐应用到精囊囊肿手术,目前国外文献仅有11例经腹腔镜行精囊囊肿切除的报告,国内未见正式报告。新近,我们成功行经腹腔镜精囊切除术1例。报告如下。     

Zinner综合征1例报告

2016 年 7 月我院收治了 1 例术前诊断为左侧输尿管肿瘤、左肾缺如,术中发现实为先天性左侧精囊囊肿并左肾缺如、左侧输尿管异位开口于精囊的患者,此病罕见,因由Zinner首次报道故名Zinner综合征.现报告如下.     

后腹腔镜腹膜后囊性淋巴管瘤切除术1例报道并文献复习

正2013年5月我科收治右侧腹膜后囊性淋巴管瘤1例,现报道如下:1病历资料患者,女,61岁,因"查体发现右肾囊肿1周"入院。患者1周前于当地医院行彩超检查时发现"右肾囊肿",平素身体健康,无腰背部疼痛不适,无发热,无尿急、尿频、尿痛及明显肉眼血尿,无厌食油腻等不适。入我科后于我院行彩超检查示:肝脏与右肾之间囊性占位,直径约5.0cm×4.0cm。行强化CT示:肝脏与右肾之间囊性占位,强化后无造影剂充盈。请我院普外科会诊,认为淋巴囊肿可能性大,囊肿较大,对肝脏及右肾有压迫症状,具有明确的手术指征。遂充分术前准备后在全麻下行后腹腔镜下右腹膜后囊肿切除术,术中见右侧腹膜     

Diagnosis and treatment of seminal vesicle cysts

Aim: To deepen the understanding of patients with seminal vesicle cysts for correct diagnosis and treatment. Patients and Methods: Five patients with seminal vesicle cysts were treated over the period January 1996–May 2010. Their symptoms, diagnostic results, treatment and outcomes were analysed retrospectively. The mean age of these patients at diagnosis was 35 years (range: 20–45). Symptoms included haematospermia in three patients, urinary frequency in three patients, perineal malaise in four patients, infertility in three patients, pain after ejaculation in three patients, scrotal pain in three patients and dysuria in one patient. Cysts were palpable in four patients on digital rectal examination. All patients underwent intravenous urography and cystoscopy. Some patients received ultrasonography, computed tomography (CT) scanning, magnetic resonance imaging (MRI) or vasovesiculography. The size of the masses ranged from 3.8 cm × 3 cm × 2.6 cmto approximately 9.6 cm × 5.2 cm × 5 cm. Final open surgery consisted of vesiculectomy in two patients and laparoscopic excision of a partial seminal vesical cyst in three patients. Results: The postoperative course was uneventful, except for one patient who complained of ureter pain. All patients were free of symptoms after open surgery. Conclusions: Seminal vesicle cysts are rare, but should be considered in men with haematospermia and otherwise inexplicable bladder irritation symptoms, perineal discomfort or other genitourinary complaints of unknown aetiology. Diagnosis consists of digital rectal examination, transrectal and abdominal ultrasonography, CT scanning and MRI. Laparoscopic excision of seminal vesical cysts produced excellent results.     

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

This study aims to emphasise the importance of imaging in the diagnosis and treatment decision-making in Zinner syndrome and provide a classification for seminal vesicle cysts. The data of six patients with Zinner syndrome in a single institution were collected. All patients underwent a contrast-enhanced computed tomography (CT) exam. Among these patients, five patients also underwent an magnetic resonance imaging (MRI). These results were combined with the review of available literature to classify the seminal vesicle cysts. Among these patients, two patients had urinary urgency and frequency, while four patients had no urinary symptoms. No reproductive-system symptoms were revealed. The imaging revealed left-sided involvement in two patients and right-sided involvement in four patients. The associated features included ipsilateral renal agenesis, seminal vesicle cyst or agenesis, and ejaculatory duct obstruction. Either an ipsilateral ureterocele or an ipsilateral small testis was noted. The seminal vesicle cysts demonstrated varying attenuation or intensity in the imaging. Imaging (CT and especially MRI) can be critical in the noninvasive diagnosis of Zinner syndrome and in allowing aberrant anatomy to be displayed for possible surgery. The proposed seminal vesicle cyst imaging classification could potentially contribute to clinical decision-making.     

精囊囊肿的诊断和治疗

目的　提高对精囊囊肿的认识 ,以利于正确诊断和有效治疗。　方法　对 16例精囊囊肿患者的诊断和治疗情况进行回顾性总结。 16例患者临床表现以血精最为多见 ,其次为膀胱刺激症状和会阴部不适或疼痛。行直肠指检、B超、CT及MRI等进行诊断。肿物大小为 3 8cm× 3 0cm×2 6cm～ 9 6cm× 5 2cm× 5 0cm ,16例均经病理证实。均行开放性手术治疗 ,其中行精囊切除术12例 ,精囊部分切除术 4例。　结果　 16例均治愈出院。除外 1例患者术后出现附睾炎治愈外 ,均无其它并发症的发生。随访 10例患者 (6例失访 ) 1个月至 2 2年 ,临床症状均消失 ,复查B超或CT均未见囊肿复发。　结论　对血精和难以解释的膀胱刺激症状或尿道生殖系的主诉要考虑患有本病可能 ;直肠指检、影像学检查为精囊囊肿诊断的主要手段。精囊切除术及精囊部分切除术具有良好的效果。     

A case of CA19-9-producing seminal vesicle cyst with ipsilateral renal agenesis

A case of CA19-9-producing seminal vesicle cyst with ipsilateral renal agenesis is reported. A 29-year-old man was admitted to our hospital for perineal pain and urinary retention. Digital rectal examination revealed a large soft mass that fluctuated in the area of the prostate and seminal vesicles. Magnetic resonance imaging revealed a right kidney defect, and ipsilateral dilation and cystic enlargement of the right seminal vesicle. Transrectal puncture of the seminal vesicle cyst was performed. The contents were pus and old red blood cells. Initially, the serum CA19-9 level was extremely high (145.8 U/ml) but was normalized by the treatment with antibiotics after the puncture. The symptoms subsided without recurrence.     

Right renal agenesis and ureter ectopic abouchement in cystic dilation of seminal vesicle

The association of a seminal vesicle cyst with ipsilateral renal agenesis was initially reported in 1914 by Zinner, and it is a very rare congenital anomaly. The association of this anomaly with an ectopic ureter entering the seminal vesicle cyst is even less common. In these cases, clinical symptoms appear in patients 15 years or older due to the distention of the seminal vesicle caused by the secretions of the reproductive tract. Perineal discomfort and recurrent epididymitis are the most often presentations. Urogenital upper tract image studies are mandatory in the management of a cystic pelvic mass and magnetic resonance imaging (MRI) is the best of this radiographic studies, that also reveals the ectopic ureter draining into the seminal vesicle. We report an additional case of this rare congenital anomaly where only MRI provided a correct preoperative diagnosis and a right surgical approach.     

Seminal vesicle cyst and ipsilateral renal agenesis: laparoscopic approach

Seminal vesicle cysts with ipsilateral renal agenesis is rare. When the patient is symptomatic, surgical treatment may be necessary. However, the seminal vesicle is difficult to access surgically, and current transurethral or open surgical approaches have inherent shortcomings. The laparoscopic techniques developed in the last decade may overcome the difficulties in the surgical treatment of seminal vesicle pathology. In this study we report a patient diagnosed with left seminal vesicle cyst and ipsilateral renal agenesis who was managed successfully through the laparoscopic approach. The patient was a 41-year-old who suffered from perineal pain and intermittent hemospermia for 20 years. Ultrasonography and computerized tomography, CT, indicated a cyst of the left seminal vesicle and an absent left kidney. The total laparoscopic operation time was 90 minutes and the estimated blood loss was 80 ml. With a follow-up of 13 months, the patient had total relief of his preoperative symptoms without complication.     

Robot-assisted management of Zinner’s syndrome: report of seminal vesicle sparing technique and review of literature

The range of urological procedures performed with robotic assistance has widened with increasing experience with the da Vinci robotic system. We describe the use of the da Vinci SI Surgical System for excision of a seminal vesicle cyst in a patient who had associated ipsilateral renal agenesis (Zinner’s syndrome). The robotic platform afforded a minimally invasive procedure with precise dissection and no collateral damage to neighbouring vital anatomy.     

Laparoscopic management of congenital seminal vesicle cysts associated with ipsilateral renal agenesis

PURPOSE: Congenital cysts of the seminal vesicles associated with ipsilateral renal abnormalities are rare. When they are symptomatic, open surgical excision has been the treatment of choice. We present our experience with laparoscopic management and provide a detailed literature review of this entity. MATERIALS AND METHODS: Since 1985, 3 patients with symptomatic seminal vesicle cysts and ipsilateral renal agenesis have been treated at our center. Open surgical excision was performed in 1 patient and laparoscopic management was performed in the other 2. RESULTS: Mean patient age was 35.7 years (range 30 to 42). Presenting symptoms were perineal pain in all 3 cases, dysuria in 2, irritable voiding in 2 and testicular pain in 1. Mean laparoscopic operative time was 195 minutes and mean estimated blood loss was 325 cc. Transabdominal or transrectal ultrasound was performed in 2 cases and computerized tomography was performed in all 3. CONCLUSIONS: Seminal vesicle cysts associated with ipsilateral renal agenesis are rare but they should be considered in men with otherwise inexplicable irritable voiding symptoms, perineal discomfort or other genitourinary complaint of unclear etiology. Evaluation should include digital rectal examination, transrectal and transabdominal ultrasound, computerized tomography and cystoscopy. Laparoscopy provides excellent intraoperative access and visualization with minimal postoperative morbidity. It is likely to become the treatment of choice for this rare developmental anomaly.     

Atrofia renal izquierda y abocamiento ureteral a vesícula seminal. tratamiento quirúrgico laparoscópico

Renal atrophy with an ectopic drainage of the ureter is an uncommon malformation. Zinder described in 1914 a cystic dilation of the seminal vesicle in association with an ipsilateral renal agenesis. Usually, these patients present lower urinary tract symptoms with perineal discomfort and fever. The most accurate diagnosis is given by the MRI, while CT and ultrasonography are less precise.We present a case of a patient who goes into hospital because of left lumbar pain and urinary sepsis data, whose CT detects an ectopic drainage of the left uereter in the seminal vesicle. He underwent a successful laparoscopic surgical treatment.