(361) Zinner Syndrome: Pelvic MRI as a Diagnostic Tool in Atypical Male Sexual Dysfunction

Introduction Zinner syndrome is a rare congenital disorder of the male urogenital tract, first coined by A.Zinner in 1914. It is often asymptomatic till found incidentally in the third or fourth decade of life through diagnostic imaging. It comprises a triad of mesonephric (Wolffian) duct anomalies involving unilateral renal agenesis, ipsilateral seminal vesicle cyst and ejaculatory duct obstruction. Fewer than 300 cases have been reported in literature, and it remains an under-diagnosed entity by clinicians due to its non-specific presentation and the reliance of advanced diagnostic tools such as Magnetic Resonance Imaging, which is considered the gold standard, for definitive diagnosis. Objective To present a rare case of Zinner syndrome in a middle-aged male who presented initially with non-specific genitourinary symptoms. His symptom profile overlapped with more common urogenital conditions, however with unsuccessful attempts at resolving these problems, his diagnosis was established through advanced imaging. Methods We present a case of a 43 year old male, who sought medical attention for mild dysuria, painful ejaculation and perianal pain. Pre-radiological assessment, he was treated empirically based on a working diagnosis of balanitis and then prostatitis. Given persistence of symptoms and lack of an alternative diagnosis, with normal biochemistry and urinalysis, he underwent an MRI Pelvis which showed evidence of an extravesical cystic lesion surrounding the right ureteric orifice and T1 imaging highlighting agenesis of the right kidney. These findings first raised suspicion of a rare diagnosis of Zinner Syndrome. He was discussed at the multi-disciplinary team meetings and thoughts around surgical intervention were discussed. Results The patient was started on a prolonged course of ciprofloxacin for presumed prostatitis, during which time his symptoms significantly improved. Due to resolution of pain and improvement in quality of life, interventional procedures, including transperineal aspiration or robotic seminal vesicle excision were deferred. The patient was discharged with plans for ongoing clinical monitoring. Conclusions Zinner syndrome, while rare, should be considered in men presenting with persistent genitourinary symptoms that do not respond to conventional treatment. This case underscores the importance of advanced imaging in identifying congenital anomalies when initial clinical and laboratory evaluations are inconclusive. Conservative management may be sufficient in symptomatic cases if the patient's condition improves, with surgical options reserved for those with ongoing symptoms or complications. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Royal Bournemouth Hospital