Kwenda Elizabeth P, Locke Rachel A, Archer Jeremy S, Su Li-Ming, Shenoy Archana, DeMarco Romano T, Bayne Christopher E
Department of Urology, University of Florida College of Medicine, Gainesville, Florida, USA.
Department of Pathology, University of Florida College of Medicine, Gainesville, Florida, USA.
J Endourol Case Rep. 2020 Sep 17;6(3):198-201. doi: 10.1089/cren.2020.0020. eCollection 2020.
A 17-year-old male with Zinner syndrome, a right seminal vesicle cyst, and a solitary left kidney presented with chronic pelvic pain. Previous surgeons had attempted robot-assisted laparoscopic seminal vesicle cyst aspiration and transurethral resection of the ejaculatory duct. Neither surgery provided sustained symptom relief. Abdominal and pelvic MRI showed a cystic structure lodged between the prostate and bladder. The right seminal vesicle, kidney, and ureter were not observed. A robot-assisted laparoscopic seminal vesiculectomy was planned. Dissection distal to the right vas deferens and between the bladder neck and prostate revealed a cystic seminal vesicle-like structure. Attached to this was a tubular structure coursing deep to the vas deferens from the right renal fossa. This was presumed to be a dysplastic ureter. The dysplastic ureter was transected from the seminal vesicle and the seminal vesicle was marsupialized to the deep pelvis. Proximally, the dysplastic ureter was transected and left open. Histologic assessment of the specimen revealed an ∼12.1 cm tubular mesonephric remnant. The postoperative course was uncomplicated. At 6 months follow-up, the patient remains free of symptoms with preserved ejaculatory volume. Mesonephric duct abnormalities and symptoms present on a spectrum. We present a safe and effective resection of a mesonephric duct remnant from a 17-year-old male with Zinner syndrome. A robotic approach localized to the right allowed for excellent observation without compromising left-sided genitourinary anatomy. In males presenting with renal agenesis and pelvic symptoms, clinicians should be suspicious of Zinner syndrome and other mesonephric abnormalities.
一名17岁男性，患有齐纳综合征、右侧精囊囊肿和孤立性左肾，出现慢性盆腔疼痛。之前的外科医生曾尝试机器人辅助腹腔镜下精囊囊肿抽吸术和经尿道射精管切除术。但这两种手术均未提供持续的症状缓解。腹部和盆腔MRI显示一个囊性结构位于前列腺和膀胱之间。未观察到右侧精囊、肾脏和输尿管。计划进行机器人辅助腹腔镜下精囊切除术。在右侧输精管远端以及膀胱颈和前列腺之间进行解剖时，发现了一个囊性的精囊样结构。与此相连的是一个管状结构，从右肾窝向输精管深部延伸。推测这是一条发育异常的输尿管。将发育异常的输尿管从精囊处切断，精囊行袋形缝合至盆腔深部。在近端，将发育异常的输尿管切断并保持开放。对标本进行组织学评估显示有一个约12.1厘米的管状中肾残余物。术后过程顺利。在6个月的随访中，患者无症状，射精量保留。中肾管异常和症状表现呈一定范围。我们展示了对一名患有齐纳综合征的17岁男性中肾管残余物进行安全有效的切除。采用定位于右侧的机器人手术方法，能够在不影响左侧泌尿生殖系统解剖结构的情况下进行良好的观察。对于出现肾缺如和盆腔症状的男性，临床医生应怀疑齐纳综合征和其他中肾异常。
