Zinner Syndrome with Ectopic Ureter Emptying into Seminal Vesicle

A 66-year-old male patient in follow-up in the urology department for a non-muscle-invasive bladder cancer was detected by ultrasound to have absence of the left kidney and a cystic, multilobed image at the location of the seminal vesicle. Magnetic resonance imaging reveals left renal agenesis and the existence of multiple cysts in the ipsilateral seminal vesicle that reaches a size of 6.9×3.7 cm, as well as a ureteral remnant that opens into the seminal vesicle. The patient does not present urinary symptoms, neither pain with ejaculation nor hematuria. A triad of seminal vesicle cyst, ipsilateral renal agenesis, and ipsilateral ejaculatory duct obstruction is known as Zinner syndrome. Congenital anomalies of the seminal vesicles are rare; some of them are associated with malformations of the upper urinary system. Seminal vesicle cysts are associated with ipsilateral renal agenesis and ectopic or dysplastic ureter. Patients may remain asymptomatic and be diagnosed incidentally or may present with symptoms such as increased urinary frequency, dysuria, recurrent infections, pain with ejaculation, and perineal discomfort

Warm ischemia time length during on-clamp partial nephrectomy: does it really matter?

BaCKgroUnd: The impact of warm ischemia time (WiT) on renal functional recovery remains controversial. We examined the length of WiT>30 min on the long-term renal function following on-clamp partial nephrectomy (pn). MeThodS: data from 23 centers for patients undergoing on-clamp pn between 2000 and 2018 were analyzed. We included patients with two kidneys, single tumor, cT1, minimum 1-year follow-up, and preoperative eGFR≥60 mL/ min/1.73m2. Patients were divided into two groups according to WIT length: group I “WIT≤30 min” and group II “WiT>30 min.” a propensity-score matched analysis (1:1 match) was performed to eliminate potential confounding factors between groups. We compared egFr values, egFr (%) preservation, egFr decline, events of chronic kidney disease (CKd) upgrading, and CKd-free progression rates between both groups. Cox regression analysis evaluated WiT impact on upgrading of CKd stages. reSUlTS: The primary cohort consisted of 3526 patients: group i (n.=2868) and group ii (n.=658). after matching the final cohort consisted of 344 patients in each group. At last follow-up, there were no significant differences in median egFr values at 1, 3, 5, and 10 years (p>0.05) between the matched groups. in addition, the median egFr (%) preservation and absolute egFr change were similar (89% in group i vs. 87% in group ii, p=0.638) and (-10 in group i vs. -11 in group ii, p=0.577), respectively. The 5 years new-onset CKd-free progression rates were comparable in the non-matched groups (79% in group i vs. 81% in group ii, log-rank, p=0.763) and the matched groups (78.8% in group i vs. 76.3% in group ii, log-rank, p=0.905). Univariable Cox regression analysis showed that WiT>30 min was not a predictor of overall CKD upgrading (HR:0.953, 95%CI 0.829-1.094, P=0.764) nor upgrading into CKD stage ≥III (HR:0.972, 95%CI 0.805-1.173, p=0.764). retrospective design is a limitation of our study. ConClUSionS: our analysis based on a large multicenter international cohort study suggests that WiT length during PN has no effect on the long-term renal function outcomes in patients having two kidneys and preoperative eGFR≥60 mL/min/1.73m2,