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• W2034687687 abstract "To the Editor:I read with great interest the paper by Pace et al. (1Pace G. Paradiso G.G. Gualá L. Ranieri G. Vicentini C. Ejaculatory duct obstruction caused by a right giant seminal vesicle with an ipsilateral upper urinary tract agenesia: an embryologic malformation.Fertil Steril. 2008; 89: 390-394Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar), and I would like to make some comments on it:1.The meanings of the abbreviations EDO and TURED are not stated. They probably are “ejaculatory duct obstruction” and “transurethral resection of the ejaculatory duct.” Although both versions (abbreviated and complete) are mentioned at different times in the abstract and throughout the text, they are never the same.2.In the results section, Pace et al. comment that “cystic malformations of the pelvic seminal tract associated with ipsilateral renal agenesis are rare. The cause of the malformation is a maldevelopment of the mesonephric duct between the 4th and the 13th weeks of gestation.” And also in the discussion it is stated that “the association of a seminal vesicle cyst with ipsilateral renal agenesis was initially reported in 1914 by Zinner, and it is a rare congenital anomaly.” More than 50 cases have been described in the twentieth century and “the literature reports fewer than 120 cases.” However, it is surprising that in just 6 months, between March and September 2005, the authors studied seven cases in Mazzini Hospital, Teramo, Italy.3.As the authors point out in the introduction, the cysts of the seminal vesicles sometimes are associated with abnormal development of the mesonephric or Wolffian duct, causing a contemporary malformation of the ipsilateral upper urinary tract. Certainly, it is the mesonephric anomaly or injury that is the source of both the cyst of the seminal vesicle (Wolffian origin) and the renal agenesis, since the ureteral bud sprouts from the Wolffian duct and, moving toward the mesonephros, forms the kidney there. Moreover, at other times there can be an ectopic ureter and severe renal dysplasia. This is also what happens in women: since our embryological hypothesis (2Acién P. Embryological observations on the female genital tract.Hum Reprod. 1992; 7: 437-445PubMed Google Scholar, 3Sanchez-Ferrer M.L. Acién M.I. Sánchez del Campo F. Mayol-Belda M.J. Acién P. Experimental contributions to the study of the embryology of the vagina.Hum Reprod. 2006; 21: 1623-1628Crossref PubMed Scopus (49) Google Scholar) suggests that the vagina has a Wolffian origin (the Wolffian ducts and the Müllerian tubercle take part in its formation and development), this explains that all cases of blind hemivagina with unilateral hematocolpos are associated with ipsilateral renal agenesis. It is, therefore, the same syndrome as in the male.In another paper by the same authors (4Pace G. Paradiso G.G. Vicentini C. Mayer-Rokitansky-Küster-Hauser syndrome and the Zinner syndrome, female and male malformation of reproductive system: are two separate entities?.J Chin Clin Med. 2007; 2: 1-7Crossref PubMed Scopus (34) Google Scholar), they try to associate Zinner´s syndrome with Rokitansky syndrome on the basis of a case they had with Rokitansky syndrome and renal agenesis, but this is a different origin. We have already described that all cases of renal agenesis in the female are associated with [1] an agenesis of all the derivatives of the urogenital ridge of the same side or [2] a blind hemivagina, generally with uterine duplicity because of a failure of the inducting function of the Wolffian duct on the Müllerian duct. We now state that instead of blind hemivagina, there could exist unilateral cervicovaginal atresia with a bicornuate uterus.Therefore, the Zinner syndrome in the male must be equivalent to the syndrome of renal agenesis with ipsilateral blind hemivagina (5Acién P. Armiñana E. Garcia-Ontiveros E. Unilateral renal agenesis associated with ipsilateral blind vagina.Arch Gynecol. 1987; 240: 1-8Crossref PubMed Scopus (25) Google Scholar), and the cause would be an anomaly (there are some genetic cases) or early injury affecting the inferior portion of the Wolffian ducts and therefore the exit of the ureteral bud both in the male and in the female.I would also appreciate it if the authors would check some of our other papers (6Acién P. Acién M.I. Malformations of the female genital tract and embryological bases.Curr Women's Health Rev. 2007; 3: 248-288Crossref Scopus (23) Google Scholar) for an embryologic analysis. To the Editor: I read with great interest the paper by Pace et al. (1Pace G. Paradiso G.G. Gualá L. Ranieri G. Vicentini C. Ejaculatory duct obstruction caused by a right giant seminal vesicle with an ipsilateral upper urinary tract agenesia: an embryologic malformation.Fertil Steril. 2008; 89: 390-394Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar), and I would like to make some comments on it:1.The meanings of the abbreviations EDO and TURED are not stated. They probably are “ejaculatory duct obstruction” and “transurethral resection of the ejaculatory duct.” Although both versions (abbreviated and complete) are mentioned at different times in the abstract and throughout the text, they are never the same.2.In the results section, Pace et al. comment that “cystic malformations of the pelvic seminal tract associated with ipsilateral renal agenesis are rare. The cause of the malformation is a maldevelopment of the mesonephric duct between the 4th and the 13th weeks of gestation.” And also in the discussion it is stated that “the association of a seminal vesicle cyst with ipsilateral renal agenesis was initially reported in 1914 by Zinner, and it is a rare congenital anomaly.” More than 50 cases have been described in the twentieth century and “the literature reports fewer than 120 cases.” However, it is surprising that in just 6 months, between March and September 2005, the authors studied seven cases in Mazzini Hospital, Teramo, Italy.3.As the authors point out in the introduction, the cysts of the seminal vesicles sometimes are associated with abnormal development of the mesonephric or Wolffian duct, causing a contemporary malformation of the ipsilateral upper urinary tract. Certainly, it is the mesonephric anomaly or injury that is the source of both the cyst of the seminal vesicle (Wolffian origin) and the renal agenesis, since the ureteral bud sprouts from the Wolffian duct and, moving toward the mesonephros, forms the kidney there. Moreover, at other times there can be an ectopic ureter and severe renal dysplasia. This is also what happens in women: since our embryological hypothesis (2Acién P. Embryological observations on the female genital tract.Hum Reprod. 1992; 7: 437-445PubMed Google Scholar, 3Sanchez-Ferrer M.L. Acién M.I. Sánchez del Campo F. Mayol-Belda M.J. Acién P. Experimental contributions to the study of the embryology of the vagina.Hum Reprod. 2006; 21: 1623-1628Crossref PubMed Scopus (49) Google Scholar) suggests that the vagina has a Wolffian origin (the Wolffian ducts and the Müllerian tubercle take part in its formation and development), this explains that all cases of blind hemivagina with unilateral hematocolpos are associated with ipsilateral renal agenesis. It is, therefore, the same syndrome as in the male. In another paper by the same authors (4Pace G. Paradiso G.G. Vicentini C. Mayer-Rokitansky-Küster-Hauser syndrome and the Zinner syndrome, female and male malformation of reproductive system: are two separate entities?.J Chin Clin Med. 2007; 2: 1-7Crossref PubMed Scopus (34) Google Scholar), they try to associate Zinner´s syndrome with Rokitansky syndrome on the basis of a case they had with Rokitansky syndrome and renal agenesis, but this is a different origin. We have already described that all cases of renal agenesis in the female are associated with [1] an agenesis of all the derivatives of the urogenital ridge of the same side or [2] a blind hemivagina, generally with uterine duplicity because of a failure of the inducting function of the Wolffian duct on the Müllerian duct. We now state that instead of blind hemivagina, there could exist unilateral cervicovaginal atresia with a bicornuate uterus. Therefore, the Zinner syndrome in the male must be equivalent to the syndrome of renal agenesis with ipsilateral blind hemivagina (5Acién P. Armiñana E. Garcia-Ontiveros E. Unilateral renal agenesis associated with ipsilateral blind vagina.Arch Gynecol. 1987; 240: 1-8Crossref PubMed Scopus (25) Google Scholar), and the cause would be an anomaly (there are some genetic cases) or early injury affecting the inferior portion of the Wolffian ducts and therefore the exit of the ureteral bud both in the male and in the female. I would also appreciate it if the authors would check some of our other papers (6Acién P. Acién M.I. Malformations of the female genital tract and embryological bases.Curr Women's Health Rev. 2007; 3: 248-288Crossref Scopus (23) Google Scholar) for an embryologic analysis. Reply of the Authors: More to be learned about female and male genital tract malformationsFertility and SterilityVol. 90Issue 2PreviewReply of the Authors: Full-Text PDF" @default.
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