Is the Laparoscopic Approach Adequate for Zinner’s Syndrome? One Patient, Two Cases

Case 1In 2019, a 21-year-old patient was admitted to the emergency department with severe scrotal pain.It was learned that the patient had post-ejaculation pain for approximately three years and had experienced very severe pain attacks 3 times.There was no known history of disease or surgery, smoking, or alcohol use.No pathological findings were detected in the scrotal and abdominal examinations.Scrotal color Doppler ultrasound and urinalysis were normal.On digital rectal examination, there was minimal mass formation in the prostate.Computed tomography (CT) showed hypertrophy in the right kidney, agenesis in the left kidney, and a low-density, smoothcontoured hypodense lesion, which may belong to a cyst with a diameter of approximately 43 mm, indenting to the bladder and adjacent to the anterior seminal vesicle on the left (Figure 1).Radiological evaluation was completed using abdominal magnetic resonance imaging (MRI).On MRI, a 44x31 mm cystic structure was observed anterior to the seminal vesicles on the AbstractZinner's syndrome (ZS) was first described by Zinner in 1914.It includes unilateral renal agenesis, ipsilateral seminal vesicle cyst, and ejaculatory duct obstruction.ZS treatments ranging from medical drug therapy to laparoscopic interventions have been tried in the literature.The 21-year-old patient presented with scrotal pain after ejaculation.The diagnosis was ZS, and the patient underwent transperitoneal laparoscopic left seminal vesicle cyst excision.After two years, transurethral ejaculatory duct resection (TUR-ED) was performed at a single center because of symptomatic dilatation in the seminal vesicles.The patient's 1-year urological follow-up after TUR-ED remained normal.This presentation is a case report of a single patient and two cases that are rare in the literature.Cyst aspiration and seminal cyst excision may be considered as first-line treatment options, but the possibility of recurrence should not be forgotten.Even if seminal cyst excision is performed, it should be kept in mind that TUR-ED may be required.