1 BACKGROUND
In Zinner syndrome (ZS), surgical intervention is recommended for pediatric patients with symptomatic disease. It is believed that cyst aspiration alone may lead to symptom recurrence. Although comprehensive surgical excision is recommended to prevent recurrence, a combined approach of cyst aspiration and maximal cyst wall ablation may provide lasting symptom relief[
1].
2 CASE PRESENTATION
A 14‐year‐old male patient with a long‐standing history of lower urinary tract symptoms, primarily characterized by voiding difficulties, presented to our clinic with acute urinary retention. A urinary catheter was inserted, draining 530 mL of urine from the bladder. Renal function tests were within normal limits, with a serum creatinine level of 0.8 mg/dL and an estimated glomerular filtration rate of 102 mL/min/1.73 m². The patient had no history of recurrent urinary tract infections, reported no sexual symptoms, and was in the peripubertal stage. Pelvic magnetic resonance imaging (MRI) revealed a cystic lesion measuring approximately 5 cm × 4 cm × 3.5 cm, arising from the right posteroinferior aspect of the prostate gland. The lesion, hyperintense on both T1‐ and T2‐weighted images, was compressing the bladder. Additionally, right‐sided renal agenesis was noted. Based on these findings, a diagnosis of ZS was suspected (Figure 1).
3 METHODS
The patient underwent urethrocystoscopy using a 7.5F pediatric compact cystoscope (Karl Storz). Through the verumontanum, access to the ejaculatory duct was achieved, allowing laser ablation of the obstructing cyst wall and drainage of the seminal vesicle cyst contents. The duct opening was subsequently dilated, followed by maximal ablation of the cyst wall. During the procedure, a holmium:yttrium–aluminum–garnet (Ho:YAG) laser was applied using a 270‐μm fiber at an energy of 0.8 J and a frequency of 10 Hertz. The surgical procedure is demonstrated in detail in Supporting Information (Video S1).
4 RESULTS
The patient was discharged on the first postoperative day, and no postoperative complications were observed. The urinary catheter was removed on postoperative day three. Uroflowmetry demonstrated a maximum flow rate of 23 mL/s, a voided volume of 190 mL, and a post‐void residual of 18 mL (Figure 2). A urinary ultrasound performed 1 month after surgery revealed a 12 mm cyst at the surgical site. At the 1‐year follow‐up, the patient remained completely asymptomatic.
5 DISCUSSION
ZS is a rare congenital malformation characterized by the classic triad of ipsilateral ejaculatory duct obstruction, seminal vesicle cyst, and renal agenesis[
2]. The clinical presentation varies depending on the size of the seminal vesicle cyst, its spatial relationship with adjacent organs, and the presence of associated anomalies[
3]. In our case, the patient presented with lower urinary tract symptoms and acute urinary retention.
In symptomatic patients, various management strategies have been reported in the literature, including open and minimally invasive surgical excision via transperineal, transvesical, transabdominal, or retroperitoneal approaches[
4–
7]. Meanwhile, transurethral approaches can also be performed successfully, offering the advantage of fewer complications and a shorter recovery period[
8]. Consistent with previous reports[
9,
10], our case demonstrates that holmium laser ablation can be effectively and safely used in the treatment of seminal vesicle cysts.
6 CONCLUSIONS
For the management of large seminal vesicle cysts in ZS, a combined approach of cyst aspiration and cyst wall ablation provides an effective, safe, and durable therapeutic option.
2026 The Author(s). UroPrecision published by John Wiley & Sons Australia, Ltd on behalf of Higher Education Press.
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