seminal vesicle cysts are rarely diagnosed , but symptomatic congenital seminal vesicle cysts are reported in the literature describing zinner syndrome .
we present the case of a 26-year - old patient admitted to the urology department because of abdominal pain .
a left seminal vesicle cyst and left kidney agenesis were found on examination , and the patient qualified for laparoscopic removal of the left seminal vesicle cyst .
the peritoneum was incised between the bladder and the rectum to reveal the left seminal vesicle , which was resected from the surrounding tissue .
a tachosil ( takeda pharmaceuticals , zurich , switzerland ) hemostatic sponge was placed in the ledge after cutting the base of the seminal vesicle .
the aim of this study was to evaluate usefulness of the laparoscopic technique to remove a cystic seminal vesicle .
the patient was discharged from the hospital on the third postoperative day and remains symptom - free after 12 months .
histopathologic examination confirmed the presence of a seminal vesicle cyst , and renal agenesis and stenosis of the vas deferens suggests zinner syndrome .
symptomatic seminal vesicle cysts are a good indication for the application of a laparoscopic technique and , in our opinion , this is better than the open technique because of the view into the surgical area .
therefore , it should be used as the method of choice in treating seminal vesicle defects .
seminal vesicle cysts are a rarely diagnosed disease , seen in only 1 in 20,000 men .
most of these cysts coexist with a congenital syndrome , first described by zinner in 1914 .
zinner syndrome is characterized by the coexistence of vas deferens stenosis , renal agenesis , and an ectopic ureteral orifice in the prostatic part of the urethra or seminal vesicle .
to date , only 100 cases of zinner syndrome have been described in the literature .
although the associated vesicle cysts are generally asymptomatic , they may cause symptoms such as perineal pain , painful ejaculation , hematospermia , abnormal micturition , lower urinary tract symptoms ( luts ) , or dysuria .
the suspected presence of a cyst is based on ultrasonography ( usg ) and is confirmed by transrectal ultrasonography ( trus ) , computed tomography ( ct ) , or magnetic resonance imaging ( mri ) , which reveal fluid - filled spaces behind the bladder . in general , digital rectal examination demonstrates a large , soft , fluctuant pelvic mass in the region behind the prostate .
other methods , such as transrectal or transurethral puncture , aspiration , or transurethral resection of the seminal colliculus and vas deferens , carry the risk of recurrent cysts .
open surgery is not easy because of the location of the seminal vesicles deep beneath the bladder and the possibility of damage to the bladder and rectum .
we describe a case of a seminal vesicle cyst in a patient with zinner syndrome who underwent laparoscopic surgery .
a 26-year - old obese patient ( body mass index of 36 ) was admitted to the urology department because of recurrent abdominal and perineal pain and dysuria .
usg revealed a fluid - filled space located behind the bladder on the left side .
ct and mri confirmed the presence of a left seminal vesicle cyst with a diameter of 8 cm ( figures 1 and 2 ) and ipsilateral renal agenesis . the patient qualified for laparoscopic removal of the left seminal vesicle cyst because of persistent pain .
the patient was placed in the trendelenburg position , and a catheter was placed into the urinary bladder and maintained during the whole procedure .
trocar 1 ( 10 mm ) was added below the umbilicus for a 0-degree optic .
trocar 2 ( 5 mm ) was placed for the left assistant hand to aid use of the suction , and trocar 3 ( 5 mm ) was placed for the right assistant hand to use the retractor to hold the bowel or bladder ; these were located between the umbilicus and the anterior iliac crest on the right side .
trocar 4 ( 10 mm ) was for the right operator hand to use the harmonic scalpel or scissors , and trocar 5 ( 5 mm ) was required for the left operator hand to use the bipolar dissector ; these were placed between the umbilicus and the anterior iliac crest on the left side .
reaching the vesicorectal recess was difficult because of the patient 's obesity and numerous peritoneal adhesions from a previous appendectomy .
the first stage of treatment involved lifting the urinary bladder to reveal the vesicorectal recess .
the peritoneum was then incised between the bladder and the rectum ( figure 4 ) .
cystic formations were located after removal of the fat layer ( figure 5 ) . this failed to separate the vas deferens , which was constricted and conjoined to the seminal vesicle as previously described in zinner syndrome .
the seminal vesicle was excised using a harmonic scalpel and bipolar coagulation ( figure 6 ) .
a hemostatic sponge ( tachosil , takeda pharmaceuticals , zurich , switzerland ) was placed in the ledge after cutting off the base of the seminal vesicle ( figure 7 ) .
the excised cyst was placed in an endobag and removed from the body ( figures 8 and 9 ) .
the patient was discharged home on the third postoperative day , and there were no postoperative complications .
histopathologic examination confirmed the presence of a seminal vesicle cyst . at the time of publication , the patient remains symptom free after 12 months of constant follow - up .
a 26-year - old obese patient ( body mass index of 36 ) was admitted to the urology department because of recurrent abdominal and perineal pain and dysuria .
usg revealed a fluid - filled space located behind the bladder on the left side .
ct and mri confirmed the presence of a left seminal vesicle cyst with a diameter of 8 cm ( figures 1 and 2 ) and ipsilateral renal agenesis . the patient qualified for laparoscopic removal of the left seminal vesicle cyst because of persistent pain .
the patient was placed in the trendelenburg position , and a catheter was placed into the urinary bladder and maintained during the whole procedure .
trocar 1 ( 10 mm ) was added below the umbilicus for a 0-degree optic .
trocar 2 ( 5 mm ) was placed for the left assistant hand to aid use of the suction , and trocar 3 ( 5 mm ) was placed for the right assistant hand to use the retractor to hold the bowel or bladder ; these were located between the umbilicus and the anterior iliac crest on the right side .
trocar 4 ( 10 mm ) was for the right operator hand to use the harmonic scalpel or scissors , and trocar 5 ( 5 mm ) was required for the left operator hand to use the bipolar dissector ; these were placed between the umbilicus and the anterior iliac crest on the left side .
reaching the vesicorectal recess was difficult because of the patient 's obesity and numerous peritoneal adhesions from a previous appendectomy . the first stage of treatment involved lifting the urinary bladder to reveal the vesicorectal recess .
the peritoneum was then incised between the bladder and the rectum ( figure 4 ) .
this failed to separate the vas deferens , which was constricted and conjoined to the seminal vesicle as previously described in zinner syndrome .
the seminal vesicle was excised using a harmonic scalpel and bipolar coagulation ( figure 6 ) .
a hemostatic sponge ( tachosil , takeda pharmaceuticals , zurich , switzerland ) was placed in the ledge after cutting off the base of the seminal vesicle ( figure 7 ) .
the excised cyst was placed in an endobag and removed from the body ( figures 8 and 9 ) .
the patient was discharged home on the third postoperative day , and there were no postoperative complications .
histopathologic examination confirmed the presence of a seminal vesicle cyst . at the time of publication , the patient remains symptom free after 12 months of constant follow - up .
zinner syndrome is a rarely diagnosed disease characterized by renal agenesis , an ectopic ureteral orifice in the prostatic part of the urethra or seminal vesicle , vas deferens stenosis , and a seminal vesicle cyst .
seminal vesicle cysts are generally small ( < 5 cm ) , asymptomatic , and do not require treatment ; however , they can also achieve a much greater size .
a growing cyst may result in perineal pain , painful ejaculation , hematospermia , abnormal urination , luts or dysuria , and infertility .
digital rectal examination reveals a resilient formation palpable behind the prostate , but only usg is capable of diagnosing a cyst and determining its relative size , location , or structure .
the lesion is anechoic , has a smooth wall , and is filled with homogeneous fluid .
additional diagnostic methods such as transrectral ultrasonography , ct , or mri are used to exclude other pelvic lesions , as well as to find the causes of cyst formation and confirm the nature of a cyst .
we used ct and mri to identify a smooth - walled anechoic space , including the seminal vesicle , located behind the bladder .
the image was so characteristic that the diagnosis of zinner syndrome was beyond doubt , especially given the concurrent presence of ipsilateral renal agenesis .
cystoscopy can also help to confirm the absence of a ureteral orifice . in the patient described here ,
usg demonstrated a fluid - filled space behind the bladder and the absence of the left kidney .
initially , the patient was treated conservatively because this can sometimes elicit the desired effect .
one case of successful conservative treatment of a patient with luts symptoms for zinner syndrome has been described .
they received short - term antibiotic treatment and -blockers for 6 months , and the symptoms were resolved permanently after these treatments . in our patient ,
the predominant symptom was severe perineal and abdominal pain , which has been reported as the most common indication for surgical treatment .
the patient was obese , which was an indication for this treatment . however , reported poor effects of therapy with a high probability of cyst recurrence and the exposure of a young patient to the possible need to repeat the procedure prompted us to attempt to remove the cyst laparoscopically .
we performed the operation in a similar way to the first stage of laparoscopic radical prostatectomy with transperitoneal access , as performed in our institution between 1999 and 2002 . in accordance with the original montsouris technique , in the first stage of the operation we always prepared the seminal vesicles , reaching them through an incision in the peritoneal vesicorectal recess .
similarly , we inserted 5 trocars ( 3  10 mm and 2  5 mm ) in the typical locations for prostate resection . although numerous adhesions and a thick layer of body fat complicated the surgery , the view of the operative field was ideal after reaching the vesicorectal recess .
we clearly saw the cystically expanded left seminal vesicle and resected it from the surrounding tissue .
seo et al described 4 operations involving laparoscopic removal of seminal vesicle cysts that used 4 trocars .
treatment began by preparing the retroperitoneal space to identify the kidney and ureter and moving downward to reach the seminal vesicle .
however , jang et al reported the successful application of laparoendoscopic single - site surgery , and , as we did , they also began preparation by making an incision of the peritoneum in the vesicorectal recess to directly reach the seminal vesicle .
the literature also describes the use of a robot to remove seminal vesicle cysts with easier instrument manipulation , greater movement precision , and excellent visualization .
the operation reported here lasted 3 hours , which was slightly longer than the surgeries described by other authors ( from 100 to 180 minutes ) .
however , our patient was very obese and had numerous peritoneal adhesions from a previous complicated appendectomy , and this prolonged the time needed to reach the recess .
the preparation of the seminal vesicle using a laparoscopic technique was not difficult ; a harmonic scalpel facilitated preparation , and placing a tachosil ( takeda pharmaceuticals , zurich , switzerland ) hemostatic sponge allowed us to control bleeding from numerous small vessels .
the view into the operative field achieved with the laparoscopic technique was perfect and certainly much better than with the classical treatment ; this point is emphasized by many who use this surgical technique .
the patient was discharged home on the third postoperative day , and we did not record any intra- or postoperative complications . rather , the long hospital stay after laparoscopic surgery was a benefit of the health care system in poland . a good view of the operative field with appropriate magnification makes the procedure safer , which is extremely important in such a difficult and inconvenient location in proximity to the rectum and bladder .
it is difficult to draw general conclusions based on one case , but , as other authors have done , we emphasize that the laparoscopic or robotic technique is an excellent choice for treating seminal vesicle diseases .
the diagnosis of a seminal vesicle cyst with renal agenesis and stenosis of the vas deferens is suggestive of the very rare condition of zinner syndrome .
compared with the open technique , laparoscopic surgery is safe and , in our opinion , provides a better view of the operated area .
 introduction : seminal vesicle cysts are rarely diagnosed , but symptomatic congenital seminal vesicle cysts are reported in the literature describing zinner syndrome.case description : we present the case of a 26-year - old patient admitted to the urology department because of abdominal pain . 
 a left seminal vesicle cyst and left kidney agenesis were found on examination , and the patient qualified for laparoscopic removal of the left seminal vesicle cyst . 
 the procedure was performed with transperitoneal access using 5 trocars . 
 the peritoneum was incised between the bladder and the rectum to reveal the left seminal vesicle , which was resected from the surrounding tissue . 
 a tachosil ( takeda pharmaceuticals , zurich , switzerland ) hemostatic sponge was placed in the ledge after cutting the base of the seminal vesicle.discussion:the aim of this study was to evaluate usefulness of the laparoscopic technique to remove a cystic seminal vesicle . 
 the procedure lasted 180 minutes , and the estimated blood loss was 50 ml . 
 we did not record any intra- or postoperative complications . 
 the patient was discharged from the hospital on the third postoperative day and remains symptom - free after 12 months . 
 histopathologic examination confirmed the presence of a seminal vesicle cyst , and renal agenesis and stenosis of the vas deferens suggests zinner syndrome . 
 symptomatic seminal vesicle cysts are a good indication for the application of a laparoscopic technique and , in our opinion , this is better than the open technique because of the view into the surgical area . 
 therefore , it should be used as the method of choice in treating seminal vesicle defects . 