Epididymitis: Causes, symptoms, and treatment

In the back of the testicles, there is a coiled tube called the epididymis. This tube stores and carries sperm and is linked to the ejaculatory duct by another tube called the vas deferens.

Epididymitis is when this tube becomes painful, swollen, and inflamed.

There are two types of epididymitis. Acute epididymitis comes on suddenly, and pain and inflammation develop quickly. This kind of epididymitis lasts less than 6 weeks.

Chronic epididymitis develops slowly and has a duller pain. It is a long-term problem that lasts for longer than 6 weeks. Males of any age can be affected by the condition.

If the testicles also become inflamed and painful, then this is known as epididymo-orchitis.

Share on PinterestThe epididymis stores and carries sperm, and may become swollen and inflamed due to a bacterial infection.

The spread of a bacterial infection usually causes epididymitis. This infection will often start in the urethra, prostate, or bladder.

Two main types of infection cause epididymitis:

Sexually transmitted infection (STI)

Epididymitis caused by an STI, such as gonorrhea or chlamydia, is most common in young, heterosexual men; particularly those who have sex with multiple partners and do not use a condom.

Cases of epididymitis that are not caused by an STI are less common.

Urinary tract infection (UTI)

Epididymitis caused by a UTI occurs in children, older men, and men who have sex with men. The following factors often cause UTIs in men:

• enlarged prostate pressing on the bladder
• insertion of a catheter into the penis
• surgery on the groin, bladder, or prostate gland

Children

While cases of epididymitis in children are rare, they do occur. Often the bacterial infection will spread from the urethra or bladder.

Inflammation will usually develop due to one of the following:

• direct injury to the area
• twisting of the epididymis
• urine flowing back into the epididymis

Other causes

There are also some more unusual causes of epididymitis:

• mumps
• tuberculosis
• high doses of a medication called amiodarone, usually taken for heart rhythm problems
• groin injury
• structural problems in the urinary tract
• Behcet’s disease
• congenital kidney and bladder problems

Share on PinterestFever or chills are common symptoms of epididymitis.

Epididymitis will cause pain in one or both testicles. The affected area will also be red, swollen, and warm to touch. If it is left untreated, it will worsen over time.

Other symptoms include:

• fever
• chills
• heaviness in the affected testicle
• enlarged testicle
• affected testicle sensitive to touch
• pain in the abdomen or pelvis
• frequent urge to urinate
• burning sensation when urinating
• discharge from the end of the penis
• blood in urine
• pain when ejaculating or having sex
• fluid buildup around the testicle which may feel like a lump

Symptoms will usually depend on the cause of the epididymitis. For example, discharge from the penis is likely to be due to an STI, while the urge to urinate probably results from a UTI.

Symptoms of epididymitis can also be similar to those of testicular torsion, a condition that sees the testicle twist and cut off the blood supply and which requires emergency surgical treatment.

As a result, if a person experiences any of these symptoms they should see a doctor straight away.

In children, the most common symptoms are:

• discomfort in lower abdomen or pelvis
• a red and tender area on the side of the scrotum
• pain or burning when urinating
• discharge from the urethra
• fever

It can often be hard to tell the difference between epididymitis and testicular torsion, particularly in younger men.

Sometimes epididymitis and testicular torsion can occur at the same time.

Doctors may perform some other tests to find the cause. These include:

• rectal exam, where a doctor inserts a finger into the anus to check for an enlarged prostate
• urine and blood tests
• urine samples to test for gonorrhea and chlamydia
• ultrasound scans, to identify testicular torsion
• medical history

Treatment will be provided based on what is causing the epididymitis. If it is a bacterial infection, the doctor will probably prescribe a course of antibiotics.

If the infection was caused by an STI, the man must tell their sexual partners. They will also need to abstain from having sex until the treatment is completed.

As well as this, doctors will probably also recommend painkillers and anti-inflammatory drugs, such as ibuprofen, to reduce pain and swelling.

There are also some basic things that a person can do to reduce discomfort:

• resting lying down with the scrotum elevated
• applying an ice pack to the painful area
• wearing a scrotal support

In general, once treatment has started the pain associated with epididymitis will go within 1 to 3 days. However, some of the symptoms can take months to disappear.

In more severe cases, a person may have to stay in the hospital and may require some surgical procedures.

Follow-up exams with the doctor will also be necessary to make sure the infection has cleared up.

Share on PinterestPain and swelling can be reduced with ibuprofen.

In most cases, epididymitis clears up with antibiotics and bed rest, and there are no long-term sexual or reproductive problems.

However, the condition can return, and some complications can occur:

• abscess in the scrotum, which may require draining
• chronic epididymitis
• opening on the skin of the scrotum
• the death of testicular tissue due to a lack of blood, known as testicular infarction
• infertility

Chronic epididymitis

In the case of chronic epididymitis, doctors will not prescribe antibiotics as inflammation occurs without an infection.

Treatment includes:

• frequent warm baths
• anti-inflammatory medication that does not contain steroids
• medication to relax muscles and alter nerve messages
• anesthetic of steroid injections into the scrotum
• surgery to remove affected epididymis
• stress management techniques

Epididymitis: Causes, symptoms, and treatment

In the back of the testicles, there is a coiled tube called the epididymis. This tube stores and carries sperm and is linked to the ejaculatory duct by another tube called the vas deferens.

Epididymitis is when this tube becomes painful, swollen, and inflamed.

There are two types of epididymitis. Acute epididymitis comes on suddenly, and pain and inflammation develop quickly. This kind of epididymitis lasts less than 6 weeks.

Chronic epididymitis develops slowly and has a duller pain. It is a long-term problem that lasts for longer than 6 weeks. Males of any age can be affected by the condition.

If the testicles also become inflamed and painful, then this is known as epididymo-orchitis.

Share on PinterestThe epididymis stores and carries sperm, and may become swollen and inflamed due to a bacterial infection.

The spread of a bacterial infection usually causes epididymitis. This infection will often start in the urethra, prostate, or bladder.

Two main types of infection cause epididymitis:

Sexually transmitted infection (STI)

Epididymitis caused by an STI, such as gonorrhea or chlamydia, is most common in young, heterosexual men; particularly those who have sex with multiple partners and do not use a condom.

Cases of epididymitis that are not caused by an STI are less common.

Urinary tract infection (UTI)

Epididymitis caused by a UTI occurs in children, older men, and men who have sex with men. The following factors often cause UTIs in men:

• enlarged prostate pressing on the bladder
• insertion of a catheter into the penis
• surgery on the groin, bladder, or prostate gland

Children

While cases of epididymitis in children are rare, they do occur. Often the bacterial infection will spread from the urethra or bladder.

Inflammation will usually develop due to one of the following:

• direct injury to the area
• twisting of the epididymis
• urine flowing back into the epididymis

Other causes

There are also some more unusual causes of epididymitis:

• mumps
• tuberculosis
• high doses of a medication called amiodarone, usually taken for heart rhythm problems
• groin injury
• structural problems in the urinary tract
• Behcet’s disease
• congenital kidney and bladder problems

Share on PinterestFever or chills are common symptoms of epididymitis.

Epididymitis will cause pain in one or both testicles. The affected area will also be red, swollen, and warm to touch. If it is left untreated, it will worsen over time.

Other symptoms include:

• fever
• chills
• heaviness in the affected testicle
• enlarged testicle
• affected testicle sensitive to touch
• pain in the abdomen or pelvis
• frequent urge to urinate
• burning sensation when urinating
• discharge from the end of the penis
• blood in urine
• pain when ejaculating or having sex
• fluid buildup around the testicle which may feel like a lump

Symptoms will usually depend on the cause of the epididymitis. For example, discharge from the penis is likely to be due to an STI, while the urge to urinate probably results from a UTI.

Symptoms of epididymitis can also be similar to those of testicular torsion, a condition that sees the testicle twist and cut off the blood supply and which requires emergency surgical treatment.

As a result, if a person experiences any of these symptoms they should see a doctor straight away.

In children, the most common symptoms are:

• discomfort in lower abdomen or pelvis
• a red and tender area on the side of the scrotum
• pain or burning when urinating
• discharge from the urethra
• fever

It can often be hard to tell the difference between epididymitis and testicular torsion, particularly in younger men.

Sometimes epididymitis and testicular torsion can occur at the same time.

Doctors may perform some other tests to find the cause. These include:

• rectal exam, where a doctor inserts a finger into the anus to check for an enlarged prostate
• urine and blood tests
• urine samples to test for gonorrhea and chlamydia
• ultrasound scans, to identify testicular torsion
• medical history

Treatment will be provided based on what is causing the epididymitis. If it is a bacterial infection, the doctor will probably prescribe a course of antibiotics.

If the infection was caused by an STI, the man must tell their sexual partners. They will also need to abstain from having sex until the treatment is completed.

As well as this, doctors will probably also recommend painkillers and anti-inflammatory drugs, such as ibuprofen, to reduce pain and swelling.

There are also some basic things that a person can do to reduce discomfort:

• resting lying down with the scrotum elevated
• applying an ice pack to the painful area
• wearing a scrotal support

In general, once treatment has started the pain associated with epididymitis will go within 1 to 3 days. However, some of the symptoms can take months to disappear.

In more severe cases, a person may have to stay in the hospital and may require some surgical procedures.

Follow-up exams with the doctor will also be necessary to make sure the infection has cleared up.

Share on PinterestPain and swelling can be reduced with ibuprofen.

In most cases, epididymitis clears up with antibiotics and bed rest, and there are no long-term sexual or reproductive problems.

However, the condition can return, and some complications can occur:

• abscess in the scrotum, which may require draining
• chronic epididymitis
• opening on the skin of the scrotum
• the death of testicular tissue due to a lack of blood, known as testicular infarction
• infertility

Chronic epididymitis

In the case of chronic epididymitis, doctors will not prescribe antibiotics as inflammation occurs without an infection.

Treatment includes:

• frequent warm baths
• anti-inflammatory medication that does not contain steroids
• medication to relax muscles and alter nerve messages
• anesthetic of steroid injections into the scrotum
• surgery to remove affected epididymis
• stress management techniques

Treatment of inflammation of the vas deferens | Booking Health

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Inflammation of the vas deferens (deferentitis) most often occurs against the background of inflammatory processes in other organs of the male reproductive system. These are the posterior urethra, the epididymis, and the testis. Often, the spermatic cord is involved in the pathological process.

The disease may have a different etiology. It can be caused by sexually transmitted infections, specific or non-specific bacteria. Sometimes it is the result of an autoimmune process. Depending on the cause of inflammation of the vas deferens, different therapeutic tactics are used.

Contents

1. Principles of treatment
2. Antibacterial treatment for genital infections
3. Treatment for nonspecific deferentitis
4. Treatment in Germany

Principles of treatment

900 04

In most cases, the pathology is infectious. It can be caused by specific microorganisms (gonorrhea, chlamydia, tuberculosis, syphilis) or nonspecific bacterial flora. It includes all those bacteria that normally live in the urogenital tract, but with active reproduction or entry into the vas deferens can cause inflammation. These bacteria are introduced through medical instruments or from other foci of infection in the body.

In this case, etiotropic therapy is required. It is aimed at eliminating the main source of infection. Antimicrobials are used. The specific type of drug depends on the identified pathogen.

Before an etiotropic treatment of inflammation of the vas deferens is prescribed, an examination is carried out. Its task is to establish the type of causative agent of the pathological process. Only in this case it will be possible to count on a good result of treatment, since different antibiotics have a different spectrum of action and destroy different bacteria.

If a severe purulent inflammatory process in the vas deferens is detected, surgical treatment may be required. Otherwise, the abscess breaks through, pathological messages are formed between the organs (fistulas), and the infection spreads to other anatomical zones.

Sometimes deferentitis is of an autoimmune nature. It occurs as a result of a violation of the hematotesticular barrier. Most often this occurs as a result of surgery, trauma or a severe inflammatory process. The genotype of spermatozoa differs from the genetic composition of the somatic cells of the male body. The immune system does not attack them only because of the protection of the hemato-testicular barrier that separates the organs of the scrotum from the circulatory system of the human body. When the barrier is damaged, antisperm antibodies begin to be produced. A chronic inflammatory process develops. It may not be accompanied by severe symptoms, but leads to infertility. In such a situation, treatment is carried out only if the man wants to maintain fertility and have children in the future.

Antibacterial treatment for sexually transmitted infections

Before antibiotics are prescribed, laboratory tests are carried out. A microscopy of a urogenital smear is performed. A urethral scraping is performed, followed by a study on common sexual infections by PCR (polymerase chain reaction). The patient is examined for chlamydia, gonorrhea, trichomoniasis. It is also advisable to donate blood for syphilis.

These diagnostic tests tell the doctor the very next day which sexually transmitted infections, if any, are present in the body. Then the treatment is selected.

Antibiotics of the cephalosporin series are prescribed for gonococcal infections. Most often it is ceftriaxone, since gonococci are highly sensitive to it. Accordingly, treatment almost always ends with recovery after the first course of therapy.

Gonorrhea with the development of inflammation of the vas deferens is considered complicated. On average, deferentitis begins 4 weeks after acute gonococcal urethritis. But there are times when the duct becomes inflamed only after a few months. Treatment with ceftriaxone lasts 10-14 days. It is administered intramuscularly at 1 gram per day.

In case of inflammation of chlamydial etiology, treatment should be started as soon as possible, especially in the case of a bilateral process. Because chlamydia often initiate pronounced cicatricial changes. As a result of inflammation of the vas deferens, a man may develop obstructive infertility. At the same time, fertility is not always restored even after the cure of chlamydia due to the formation of scars that prevent the movement of sperm from the testicles into the urethra.

Chlamydia infection is treated with one of three groups of antibiotics. The most commonly used are tetracyclines (doxycycline) or macrolides (josamycin). Fluoroquinolones (levofloxacin) are used less frequently.

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Treatment for nonspecific deferentitis

It happens that sexual infections are not detected according to the results of the examination. In men, inflammation of the vas deferens can be caused by nonspecific bacterial flora. It enters the ducts from:

• Urethra
• Prostate gland
• Testicles
• Distant purulent foci in the body (through the blood or lymphatic system)

In this case, flora is inoculated. The type of bacteria that caused the inflammation is determined. The sensitivity of the isolated flora to antibiotics is assessed. Then the drug, to which the identified bacteria have maximum sensitivity, is prescribed for the treatment of the inflammatory process of the vas deferens.

In acute purulent inflammation, therapy is prescribed empirically (without antibiogram), already on the day of treatment. This is required to prevent complications. In the future, the antibiotic can be replaced after a few days, after receiving the bakposev data.

Significant purulent inflammation sometimes develops. Up to 200 ml of pus and more can accumulate in the vas deferens and surrounding tissues. In this case, a surgical operation is performed. The doctor makes an excision of the duct and drains it. The pus is removed, the wound is washed with antiseptics. In parallel, antibiotic therapy continues.

Treatment in Germany

Booking Health offers treatment in the best clinics in Germany for inflammation of the vas deferens. In German medical institutions, both conservative and surgical methods of treatment are used to solve the problem of deferentitis as soon as possible.

You can undergo complex treatment of benign and malignant pathologies of the urological spectrum at the Helios Clinic Berlin-Buch, an academic clinic of the Charité medical complex with more than a century of history. The Department of Urology, under the direction of Prof. Dr. med. Mark Schrader, provides medical, endourological and minimally invasive treatment of benign diseases of the genitourinary system in men (urethral stenosis, prostatic hyperplasia, urolithiasis), as well as the treatment of malignant tumors of the kidneys and bladder, prostate, testicles, penis. The specialists of the department actively cooperate with colleagues from other departments of the clinic – for example, thanks to cooperation with the Department of Nuclear Medicine, patients can be treated with therapeutic radionuclides. The head physician of the department has a GCP certificate in the field of drug research, as well as additional qualifications in the field of drug therapy for oncological pathologies.

Benefits of contacting German clinics:

• Accurate diagnostics that allows you to accurately determine the type of causative agent of the pathological process, identify or exclude sexual infections.
• Etiotropic therapy using modern antibacterial drugs.
• Surgical treatment if necessary. Operations are carried out by world-renowned specialists.
• Minimal risk of reduced fertility as a result of surgical treatment.
• In case of development of obstructive infertility, it is possible to perform reconstructive operations on the vas deferens, which will restore the natural fertility of a man.

Booking Health staff will select the best clinic and treatment program for you. When choosing a medical institution, statistics on this disease and the cost of treatment will be taken into account. Thanks to Booking Health, you save on medical services and get medical care faster. In addition, the company solves all organizational issues for you. Therefore, you can only focus on restoring your own health.

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Authors:

The article was edited by experts in the field of medicine, medical specialists Doctor Nadezhda Ivanisova, Doctor Sergey Pashchenko. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-treatment! 9

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Experience in the treatment of patients with Zinner’s syndrome

In the process of embryogenesis, the development of the kidney goes through three stages – pronephros, primary and final kidneys, developing from the mesoderm. The pronephros and primary kidneys gradually undergo reverse development, with the exception of the duct of the primary kidney, or Wolffian duct, which is involved in the formation of the urinary tract, the male genital ducts (vas deferens and ejaculatory), the epididymis and the seminal vesicle. In the place of the bend of the Wolffian duct, before flowing into the cloaca, the ureteral outgrowth appears. The underdevelopment of the distal part of the mesonephros, as well as the absence of the ureteral outgrowth on one side, lead to atresia of the vas deferens, unilateral agenesis/dysgenesis of the kidney, and the formation of a half triangle of the bladder [1].

Zinner’s syndrome develops due to the pathology of the Wolffian duct (mesonephros) and includes unilateral renal agenesis (according to some reports, dysgenesis), seminal vesicle cyst on the side of the absence of the kidney, and obstruction of the vas deferens [2]. Obstruction of the vas deferens leads to a gradual accumulation of secretions in the seminal vesicles and the subsequent formation of a cyst. The disease was first described by A. Zinner in 1914 [3], so far, about 100 cases of the disease have been described in the literature [4], and the incidence rate is 0.00464%. Zinner’s syndrome is also called the male “analogue” of the Mayer-Rokitansky-Kuster-Hauser syndrome (vaginal atresia syndrome) [5]. R. Casey et al. [6] reported a unique pentad of pathology of the mesonephrotic duct, including cystic dysplasia of the tubular network of the testes, seminal vesicle cyst, ipsilateral renal agenesis, dilatation of the epididymis, and partial development of the triangle of the bladder.

In this article, we present our own experience in diagnosing and treating 3 patients with Zinner’s syndrome.

Case study 1

Patient A. , 32 years old, applied to the Urology Clinic of Moscow State Medical University with complaints of hyperthermia up to 37.0-37.3 °C in the evening for 4 months before the present hospitalization, difficulty urinating with a sluggish stream, pain in the perineum, episodes of acute urinary retention, spontaneously resolved. The patient is single and has no children. From the anamnesis it is known that at the age of 16, an outpatient ultrasound examination (ultrasound) revealed a single left kidney. Subsequently, in another medical institution, ultrasound revealed the formation of the bladder (Fig. 1) .Fig. 1. Transabdominal ultrasound of patient A.

Prior to visiting the Urology Clinic of Moscow State University of Medicine and Dentistry, the patient consulted several times in various specialized medical institutions in Moscow, as well as in the Urological Clinic of Israel: surgical treatment in the form of open or laparoscopic cystectomy was recommended. However, due to the possible development of side complications, the patient refused surgical treatment. Further examination, which included magnetic resonance therapy (MRI) of the organs of the urinary system, confirmed the absence of the right kidney and moderate hypertrophy of the left kidney, revealed the presence of a cyst with a diameter of 45 mm in the area of ​​the right seminal vesicle (Fig. 2) . Figure 2. MRI of patient A. In the analysis of spermogram – no pathology.

A conversation was held with the patient regarding the existing disease and existing methods of treatment. The patient insisted on conservative treatment. It was decided to perform a puncture of the cyst of the right seminal vesicle under local anesthesia under the control of transrectal ultrasound (TRUS). During the manipulation, about 30 ml of chocolate-colored liquid was obtained, the tissue of the cyst wall was taken for histological examination, the liquid was sent for bacteriological culture and cytological examination (Fig. 3) Figure 3. Fluid evacuated during cyst puncture under TRUS guidance. The next day after the puncture of the cyst, the patient noted an improvement in his general condition, a decrease in pain symptoms in the perineal region.

After 1 year, the patient underwent a second puncture of the cyst of the seminal vesicle. The volume of liquid during repeated puncture was 20 ml.

Case study 2

Patient In ., 42 years old, for a long time noted periodic (1 every 4 months) admixture of blood in the semen, a single admixture of blood in the urine, a moderate deterioration in the quality of urination. The patient is married, has no children, uses barrier methods as contraception. Regarding the admixture of blood in the semen, he was not examined, he did not go to the doctors, linking the existing condition with physical activity. From the anamnesis it is known that in childhood he was diagnosed with agenesis of the right kidney. During a routine medical examination, ultrasound revealed the formation of the bladder. Taking into account the presence of blood impurities in the urine and semen, the urologist of the district polyclinic made a preliminary diagnosis of a bladder tumor. The patient was consulted at the Urology Clinic of the Moscow State Medical University. Transabdominal ultrasound revealed a round formation with clear contours in the bladder cavity, which had a liquid component (Fig. 4) .Fig. 4. Transabdominal ultrasound of patient B.

Computed tomography (CT) of the organs of the urinary system confirmed the diagnosis of agenesis of the right kidney, a cyst with a diameter of 25 mm was detected in the projection of the right seminal vesicle (Fig. 5) . bladder cavity.

In the analysis of spermogram – no pathology. It was decided to perform a puncture of the cyst of the right seminal vesicle under local anesthesia under TRUS control (Fig. 6) . Figure 6. Puncture of the cyst of the right seminal vesicle of patient B. under TRUS control. During the puncture, about 25 ml of chocolate-colored liquid was evacuated.

Case study 3

Patient S. , 20 years old, upon admission to the Urology Clinic of Moscow State Medical University, complained of frequent urination, periodic pain in the scrotum and perineum, painful ejaculation. The patient is single, has no children, does not lead a sexual life. From the anamnesis it is known that the above complaints have been disturbing for 1 year. An outpatient multislice CT scan of the urinary system revealed agenesis of the left kidney. Examination in laboratory analyzes and spermogram showed no pathology, excretory urography revealed a filling defect in the projection of the bladder, the pelvicalyceal system of the right kidney was contrasted (Figure 7) Figure 7. Excretory urography of patient C.

According to ultrasound data, a cyst with a volume of about 20 cm ³ was revealed in the projection of the left seminal vesicle. The cyst was punctured under TRUS control, about 15 ml of “chocolate” liquid (Fig. 8) was evacuated.

To date, patients continue to be observed. In the course of dynamic observation during TRUS, a tendency to a gradual decrease in the volume of the cyst was noted.

Talk

Zinner’s syndrome is usually diagnosed in the third or fourth decade of life and is often accompanied by infertility [7]. A seminal vesicle cyst may be initially congenital or develop as a result of a chronic inflammatory process or obstruction of the vas deferens [8]. Often, a seminal vesicle cyst is asymptomatic or with minor clinical manifestations, such as perineal pain and/or dysuria. The cyst of the seminal vesicle can be quite large in size and protrude into the lumen of the bladder. In this case, the cyst can be detected by ultrasound [9].

Unilateral aplasia of the vas deferens is also associated with the absence of a kidney [10]. Obstruction at the level of the vas deferens is the most common cause of acquired obstructive azoospermia [11], which can eventually lead to infertility, the main complication of Zinner’s syndrome. Congenital obstruction of the vas deferens should be differentiated from acquired obstruction, which often occurs as a result of an iatrogenic injury during inguinal hernia repair [12].

In patients with cystic fibrosis, congenital bilateral absence of the vas deferens (CBAVD) may be the cause of obstruction. Unilateral agenesis or partial defect of the vas deferens is often associated with abnormalities of the contralateral duct or renal agenesis in 80% and 26% of cases, respectively [13].

This fact emphasizes the need for a detailed examination of patients with suspected Zinner’s syndrome and a differential diagnosis with “similar” diseases.

Patients must undergo an ultrasound of the scrotum, which helps to identify signs of obstruction (expansion of the testicular network, enlargement of the epididymis with cystic changes, or absence of the vas deferens). For patients with a small volume of ejaculate (<1.5 ml) and suspected duct obstruction, TRUS in two projections is indicated. TRUS can also be used to aspirate the contents of seminal vesicles [14].

Many authors have proposed various methods for the treatment of patients with seminal vesicle cyst in combination with renal agenesis. According to B. Pereira et al. [15], conservative symptomatic therapy, as well as dynamic observation, are the preferred options in the absence of clinical manifestations of the disease. In case of ineffectiveness of conservative methods of treatment, the most justified is surgical tactics.

The possibility of robot-assisted cystectomy of the seminal vesicle in a patient with kidney dysplasia and incomplete duplication of the ureters was described by E. Altobelli et al. [16].

G. Pace et al. [17] presented data from a retrospective analysis of the treatment of 7 patients with Zinner’s syndrome who underwent transurethral resection of the ejaculatory duct outlets in the zone of the seminal tubercle – TURED (transurethral resection of the ejaculatory ducts) operation. The authors concluded that after the operation, spermogram parameters can be significantly improved, which can positively affect reproductive function. A number of authors [18] also noted that in cases of functional obstruction of the distal ejaculatory ducts, TURED surgery also often improves ejaculate ejection. Intraoperative TRUS with a rigid transducer makes the operation safer, and the introduction of indigo carmine into the vas deferens helps to assess the restoration of patency of the vas deferens [19].

Complications after TURED include retrograde ejaculation due to damage to the bladder neck and reflux of urine into the seminal vesicles, ejaculatory and vas deferens. In the future, this can lead to low sperm motility, oxidation of the environment in the ejaculate and epididymitis.

According to the 2013 EAU Guidelines, an alternative to TURED is microsurgical epididymal spermatozoa extraction – MESA (Microsurgical epididymal sperm aspiration), testicular sperm extraction – TESE (testicular sperm extraction), spermatozoa aspiration from the proximal part of the vas deferens, from seminal vesicles under ultrasound control and direct aspiration of seminal fluid from the cyst [20].

Conclusion

Zinner’s syndrome is a disease to be suspected in male patients with renal agenesis and a diagnosed mass in the projection of the bladder. In most cases, the symptoms of the disease are hematuria, hemospermia, hypospermia, impaired ejaculation, and discomfort in the perineum after ejaculation.