Ejaculatory Duct Obstruction in the Setting of an Ectopic Ureter

Abstract

Abstract Introduction A 17-year-old man was referred to a tertiary care urologist for hematuria, hematospermia, and testalgia. The patient had a history of right-sided renal dysgenesis at birth. Methods Fluoroscopic investigation with retrograde seminal vesiculography demonstrated the right ureter implanted ectopically into the right ejaculatory duct. Magnetic resonance imaging of the pelvis showed the ectopic ureter present proximally from the level of the external iliac vessels and implanting into a cystic dilatation on the posterolateral aspect of the prostate. Robot-assisted laparoscopic nephroureterectomy was performed finding an ectopic right ureter forming a confluent cyst with the right ejaculatory duct composed of the seminal vesicle (SV) duct, ureter, and ductus deferens. Incision of the SV revealed mucin balls obstructing the ejaculatory duct. Results The nephroureterectomy and removal of the mucin balls resolved the patient’s pain at the 1-month follow-up. Conclusion Painful ejaculation or hematospermia in the presence of known renal dysgenesis may constitute Zinner’s syndrome and be an indication for pelvic magnetic resonance imaging or retrograde seminal vesiculography investigation. The classic presentation of pain with contraction of hollow organs and associated proximal dilation on imaging can be applied to the ejaculatory duct. Robot-assisted laparoscopic nephroureterectomy with preservation of the effected SV was a suitable surgical approach for both diagnostic and therapeutic purposes in this case of Zinner’s syndrome.