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Hematospermia as a Rare Form of Presentation of Zinner Syndrome
Accepted Manuscript Title: Hematospermia As A Rare Form Of Presentation Of Zinner Syndrome Author: Nelson Canales-Casco, Alejandro Dominguez-Amillo, Miguel Angel Arrabal-Polo, Francisco Javier Sanchez-Tamayo, Miguel Arrabal-Martin, Jose Manuel Cozar-Olmo PII: DOI: Reference:
S0090-4295(16)30647-1 http://dx.doi.org/doi: 10.1016/j.urology.2016.09.030 URL 20048
To appear in:
Urology
Received date: Accepted date:
3-8-2016 21-9-2016
Please cite this article as: Nelson Canales-Casco, Alejandro Dominguez-Amillo, Miguel Angel Arrabal-Polo, Francisco Javier Sanchez-Tamayo, Miguel Arrabal-Martin, Jose Manuel CozarOlmo, Hematospermia As A Rare Form Of Presentation Of Zinner Syndrome, Urology (2016), http://dx.doi.org/doi: 10.1016/j.urology.2016.09.030. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
TITLE: HEMATOSPERMIA AS A RARE FORM OF PRESENTATION OF ZINNER SYNDROME Authors: Nelson Canales-Casco, Alejandro Dominguez-Amillo, Miguel Angel ArrabalPolo, Francisco Javier Sanchez-Tamayo, Miguel Arrabal-Martin, Jose Manuel CozarOlmo Urology Department. Complejo Hospitalario Universitario Granada. Spain Corresponding author: Miguel Angel Arrabal-Polo. Plaza Ciudad de los Carmenes, 4, 6ºD. Granada. Spain. Postal code: 18013. email:[email protected]
ABSTRACT A 17-year-old male was referred to the Urology department for hematospermia after initiation of sexual relationship. An MRI scan showed giant dilation of a multi-cystic left seminal vesicle with left renal agenesis. These findings are typical of the Zinner syndrome. In 70-80% of the cases when renal agenesis is found, there is an ipsilateral cystic dilation of the seminal vesicle that in some cases may be associated with testicular ectopia or absence of the bladder trigone. The ejaculatory ducts, which are formed from the mesonephric system, are abnormally developed in this cases.
Keywords: Zinner syndrome; Seminal vesicle cyst; Hemospermia Acknowledgments: No
A 17-year-old male was referred to the Urology department for hematospermia after initiation of sexual relationship. He did not have any other associated symptoms. Microbiological examination for prostatitis revealed negative results. Blood analysis showed PSA of 0.5ng/ml. Because of the persistence of hematospermia, an abdominal ultrasound was requested, which showed the presence of a cystic structure in the left
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caudal aspect of the bladder and the absence of the left kidney. An additional study with an MRI scan showed a giant dilation of a multi-cystic left seminal vesicle (Figure 1 and 2) with left renal agenesis. These findings are typical of the Zinner syndrome, which was first described in 1914 by the author with same name, and is characterized by unilateral cystic dilation of a seminal vesicle, ipsilateral renal agenesis and obstruction of the ejaculatory duct leading to progressive dilation by the lack of drainage of secretions. The seminal vesicle cyst is a rare entity that may be congenital or acquired, secondary to chronic inflammatory processes or obstruction. It is usually detected between the third and fifth decade of life, and although most patients are asymptomatic, it may present as mild perineal pain, dysuria or infertility (1-4). REFERENCES 1: Sundar R, Sundar G. Zinner syndrome: an uncommon cause of painful ejaculation. BMJ Case Rep. 2015; 2015. pii: bcr2014207618. doi: 10.1136/bcr-2014-207618. 2: García Asensio D, Fernández Martín M. Zinner syndrome diagnosed in a child. Radiologia. 2016; 58: 73-4. 3: Kuo J, Foster C, Shelton DK. Zinner's Syndrome. World J Nucl Med. 2011; 10: 20-2. 4: Ghonge NP, Aggarwal B, Sahu AK. Zinner syndrome: A unique triad of mesonephric duct abnormalities as an unusual cause of urinary symptoms in late adolescence. Indian J Urol. 2010; 26: 444-7.
FIGURE LEGEND Figure 1: Sagital view of a nuclear magnetic resonance imaging (MRI) image showing a giant left seminal vesicle cyst. Figure 2: Coronal view of an MRI image with the same cystic structure in the left caudal aspect of the bladder corresponding to the seminal vesicle.
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S0090-4295(16)30647-1 http://dx.doi.org/doi: 10.1016/j.urology.2016.09.030 URL 20048
To appear in:
Urology
Received date: Accepted date:
3-8-2016 21-9-2016
Please cite this article as: Nelson Canales-Casco, Alejandro Dominguez-Amillo, Miguel Angel Arrabal-Polo, Francisco Javier Sanchez-Tamayo, Miguel Arrabal-Martin, Jose Manuel CozarOlmo, Hematospermia As A Rare Form Of Presentation Of Zinner Syndrome, Urology (2016), http://dx.doi.org/doi: 10.1016/j.urology.2016.09.030. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
TITLE: HEMATOSPERMIA AS A RARE FORM OF PRESENTATION OF ZINNER SYNDROME Authors: Nelson Canales-Casco, Alejandro Dominguez-Amillo, Miguel Angel ArrabalPolo, Francisco Javier Sanchez-Tamayo, Miguel Arrabal-Martin, Jose Manuel CozarOlmo Urology Department. Complejo Hospitalario Universitario Granada. Spain Corresponding author: Miguel Angel Arrabal-Polo. Plaza Ciudad de los Carmenes, 4, 6ºD. Granada. Spain. Postal code: 18013. email:[email protected]
ABSTRACT A 17-year-old male was referred to the Urology department for hematospermia after initiation of sexual relationship. An MRI scan showed giant dilation of a multi-cystic left seminal vesicle with left renal agenesis. These findings are typical of the Zinner syndrome. In 70-80% of the cases when renal agenesis is found, there is an ipsilateral cystic dilation of the seminal vesicle that in some cases may be associated with testicular ectopia or absence of the bladder trigone. The ejaculatory ducts, which are formed from the mesonephric system, are abnormally developed in this cases.
Keywords: Zinner syndrome; Seminal vesicle cyst; Hemospermia Acknowledgments: No
A 17-year-old male was referred to the Urology department for hematospermia after initiation of sexual relationship. He did not have any other associated symptoms. Microbiological examination for prostatitis revealed negative results. Blood analysis showed PSA of 0.5ng/ml. Because of the persistence of hematospermia, an abdominal ultrasound was requested, which showed the presence of a cystic structure in the left
Page 1 of 3
caudal aspect of the bladder and the absence of the left kidney. An additional study with an MRI scan showed a giant dilation of a multi-cystic left seminal vesicle (Figure 1 and 2) with left renal agenesis. These findings are typical of the Zinner syndrome, which was first described in 1914 by the author with same name, and is characterized by unilateral cystic dilation of a seminal vesicle, ipsilateral renal agenesis and obstruction of the ejaculatory duct leading to progressive dilation by the lack of drainage of secretions. The seminal vesicle cyst is a rare entity that may be congenital or acquired, secondary to chronic inflammatory processes or obstruction. It is usually detected between the third and fifth decade of life, and although most patients are asymptomatic, it may present as mild perineal pain, dysuria or infertility (1-4). REFERENCES 1: Sundar R, Sundar G. Zinner syndrome: an uncommon cause of painful ejaculation. BMJ Case Rep. 2015; 2015. pii: bcr2014207618. doi: 10.1136/bcr-2014-207618. 2: García Asensio D, Fernández Martín M. Zinner syndrome diagnosed in a child. Radiologia. 2016; 58: 73-4. 3: Kuo J, Foster C, Shelton DK. Zinner's Syndrome. World J Nucl Med. 2011; 10: 20-2. 4: Ghonge NP, Aggarwal B, Sahu AK. Zinner syndrome: A unique triad of mesonephric duct abnormalities as an unusual cause of urinary symptoms in late adolescence. Indian J Urol. 2010; 26: 444-7.
FIGURE LEGEND Figure 1: Sagital view of a nuclear magnetic resonance imaging (MRI) image showing a giant left seminal vesicle cyst. Figure 2: Coronal view of an MRI image with the same cystic structure in the left caudal aspect of the bladder corresponding to the seminal vesicle.
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