ÂÑÅÐÎÑÑÈÉÑÊÈÉ ÌÅÆÄÈÑÖÈÏËÈÍÀÐÍÛÉ ÌÅÄÈÖÈÍÑÊÈÉ ÆÓÐÍÀË © Êîëëåêòèâ àâòîðîâ, 2014 ÓÄÊ 616.6-008.6 À. Î. Âàñèëüåâ À. Â. Ãîâîðîâ êàíä. ìåä. íàóê Þ. À. Êóïðèÿíîâ Ê. Á. Êîëîíòàðёâ êàíä. ìåä. íàóê Ä. Þ. Ïóøêàðü äîêò. ìåä. íàóê Ìîñêîâñêèé ãîñóäàðñòâåííûé ìåäèêî-ñòîìàòîëîãè÷åñêèé óíèâåðñèòåò èì. À. È. Åâäîêèìîâà Ñèíäðîì Öèííåðà: îïèñàíèå êëèíè÷åñêèõ ñëó÷àåâ Ñèíäðîì Öèííåðà – âðîæäåííîå ñîñòîÿíèå, õàðàêòåðèçóþùååñÿ íàëè÷èåì êèñòû ñåìåííîãî ïóçûðüêà â ñî÷åòàíèè ñ èïñèëàòåðàëüíîé àïëàçèåé ïî÷êè è îáñòðóêöèåé ñåìÿâûíîñÿùåãî ïðîòîêà. Ýòî ðåäêàÿ óðîëîãè÷åñêàÿ àíîìàëèÿ ðàçâèòèÿ, ÷àùå âñåãî õàðàêòåðèçóþùàÿñÿ áåññèìïòîìíûì òå÷åíèåì è ïðèâîäÿùàÿ ê áåñïëîäèþ.  íåêîòîðûõ ñëó÷àÿõ ïàöèåíòîâ áåñïîêîÿò áîëè â ìîøîíêå è ïðîìåæíîñòè, áîëåçíåííîå ñåìÿèçâåðæåíèå, ãåìîñïåðìèÿ, äèçóðèÿ. Ó áîëüøèíñòâà ïàöèåíòîâ ñèíäðîì Öèííåðà âûÿâëÿåòñÿ â ïîëîâîçðåëîì âîçðàñòå ñëó÷àéíî ïðè îáñëåäîâàíèè. Ñîâðåìåííûå ìåòîäû âèçóàëèçàöèè ñïîñîáñòâóþò ðàííåé äèàãíîñòèêå çàáîëåâàíèÿ è, êàê ñëåäñòâèå, ïðîôèëàêòèêå áåñïëîäèÿ. Ñèìïòîìàòè÷åñêàÿ òåðàïèÿ, à òàêæå äèíàìè÷åñêîå íàáëþäåíèå ïðè îòñóòñòâèè êëèíè÷åñêèõ ïðîÿâëåíèé ÿâëÿþòñÿ ïðåäïî÷òèòåëüíûìè âàðèàíòàìè ëå÷åíèÿ. Ïðè îòñóòñòâèè ýôôåêòèâíîñòè êîíñåðâàòèâíîé òåðàïèè ïàöèåíòó ïîêàçàíî õèðóðãè÷åñêîå ëå÷åíèå îòêðûòûì èëè ëàïàðîñêîïè÷åñêèì (ðîáîòàññèñòèðîâàííûì) äîñòóïîì. Ñâîåâðåìåííîå âûÿâëåíèå è ëå÷åíèå ñèíäðîìà Öèííåðà ïîçâîëÿåò óëó÷øèòü ïîêàçàòåëè ñïåðìîãðàììû, ÷òî äàåò âîçìîæíîñòü ïàöèåíòàì ðåàëèçîâàòü ðåïðîäóêòèâíóþ ôóíêöèþ.  äàííîé ñòàòüå ìû îïèñûâàåì òðè ñëó÷àÿ âðîæäåííîé àíîìàëèè (êèñòû) ñåìåííûõ ïóçûðüêîâ ó ïàöèåíòîâ 20, 32 è 42 ëåò â ñî÷åòàíèè ñ èïñèëàòåðàëüíîé àïëàçèåé ïî÷êè. Êëþ÷åâûå ñëîâà: ñèíäðîì Öèííåðà, êèñòà ñåìåííîãî ïóçûðüêà, àïëàçèÿ ïî÷êè Ñèíäðîì Öèííåðà ðàçâèâàåòñÿ âñëåäñòâèå ïàòîëîãèè ïðîòîêà ïåðâè÷íîé ïî÷êè (ìåçîíåôðîñà) è âêëþ÷àåò îäíîñòîðîííþþ ïî÷å÷íóþ àïëàçèþ (ïî íåêîòîðûì äàííûì — äèñïëàçèþ), êèñòó ñåìåííîãî ïóçûðüêà íà ñòîðîíå îòñóòñòâèÿ ïî÷êè è îáñòðóêöèþ ñåìÿâûíîñÿùåãî ïðîòîêà [1]. Îáñòðóêöèÿ ñåìÿâûíîñÿùåãî ïðîòîêà ïðèâîäèò ê ïîñòåïåííîìó íàêîïëåíèþ ñåêðåòà â ñåìåííûõ ïóçûðüêàõ è ïîñëåäóþùåìó îáðàçîâàíèþ êèñòû. Çàáîëåâàíèå âïåðâûå îïèñàë A. Zinner â 1914 ã. [2], äî íàñòîÿùåãî âðåìåíè â ëèòåðàòóðå îïèñàíî îêîëî ñòà ñëó÷àåâ çàáîëåâàíèÿ, à ÷àñòîòà âñòðå÷àåìîñòè ñîñòàâëÿåò 0,00464 % [3].  ïîñëåäóþùåì áûëà îïèñàíà óíèêàëüíàÿ ïåíòàäà ïàòîëîãèè ìåçîíåôðîòè÷åñêîãî ïðîòîêà, âêëþ÷àþùåé êèñòîçíóþ äèñïëàçèþ êàíàëüöåâîé ñåòè ÿè÷åê, êèñòó ñåìåííîãî ïóçûðüêà, èïñèëàòåðàëüíóþ àïëàçèþ ïî÷åê, äèëàòàöèþ ïðèäàòêà ÿè÷êà è ÷àñòè÷íîå ðàçâèòèå òðåóãîëüíèêà ìî÷åâîãî ïóçûðÿ [4]. Àëåêñàíäð Îëåãîâè÷ Âàñèëüåâ e-mail: alexvasilyev@me.com 52  äàííîé ñòàòüå ìû ðàññêàçûâàåì î ñîáñòâåííîì îïûòå äèàãíîñòèðîâàíèÿ è ëå÷åíèÿ òðåõ ïàöèåíòîâ ñ ñèíäðîìîì Öèííåðà. Êëèíè÷åñêèé ïðèìåð № 1 Ïàöèåíò À., 32 ãîäà, îáðàòèëñÿ â êëèíèêó óðîëîãèè ÌÃÌÑÓ ñ æàëîáàìè íà ãèïåðòåðìèþ â âå÷åðíåå âðåìÿ äî 37,0–37,3° Ñ â òå÷åíèå 4 ìåñ äî íàñòîÿùåé ãîñïèòàëèçàöèè, çàòðóäíåííîå ìî÷åèñïóñêàíèå âÿëîé ñòðóåé, áîëè â îáëàñòè ïðîìåæíîñòè, ýïèçîäû îñòðîé çàäåðæêè ìî÷è, ñàìîïðîèçâîëüíî ðàçðåøàâøèåñÿ. Ïàöèåíò õîëîñò, äåòåé íå èìååò. Èç àíàìíåçà èçâåñòíî, ÷òî â 16-ëåòíåì âîçðàñòå ïðè àìáóëàòîðíîì ÓÇÈ áûëà âûÿâëåíà åäèíñòâåííàÿ ëåâàÿ ïî÷êà.  ïîñëåäóþùåì â äðóãîì ËÏÓ ïðè ÓÇÈ âûÿâëåíî îáðàçîâàíèå ìî÷åâîãî ïóçûðÿ. Äî îáðàùåíèÿ â êëèíèêó óðîëîãèè ÌÃÌÑÓ ïàöèåíò íåîäíîêðàòíî êîíñóëüòèðîâàëñÿ â ðàçëè÷íûõ ñïåöèàëèçèðîâàííûõ ìåäèöèíñêèõ ó÷ðåæäåíèÿõ Ìîñêâû, à òàêæå â óðîëîãè÷åñêîé êëèíèêå Èçðàèëÿ: ðåêîìåíäîâàíî îïåðàòèâíîå ëå÷åíèå â îáúåìå îòêðûòîé èëè ëàïàðîñêîïè÷åñêîé êèñòýêòîìèè. Îäíàêî â ñâÿçè ñ âîçìîæíûì ðàçâèòèåì ïîáî÷íûõ îñëîæíåíèé ïàöèåíò îò îïåðàòèâíîãî ëå÷åíèÿ îòêàçàëñÿ. Äàëüíåéøåå www.terramedica.spb.ru TERRA MEDICA® № 2/ 2014 îáñëåäîâàíèå, âêëþ÷àâøåå ÒÐÓÇÈ è ÌÐÒ îðãàíîâ ìî÷åâûäåëèòåëüíîé ñèñòåìû, ïîäòâåðäèëî îòñóòñòâèå ïðàâîé ïî÷êè è óìåðåííóþ ãèïåðòðîôèþ ëåâîé ïî÷êè, âûÿâèëî íàëè÷èå êèñòû äèàìåòðîì 45 ìì â îáëàñòè ïðàâîãî ñåìåííîãî ïóçûðüêà (ðèñ. 1). Êëèíè÷åñêèé ïðèìåð № 2 Ïàöèåíò Â., 42 ãîäà, â òå÷åíèå äëèòåëüíîãî âðåìÿ îòìå÷àë ïåðèîäè÷åñêóþ (ðàç â 4 ìåñ) ïðèìåñü êðîâè â ñïåðìå, îäíîêðàòíóþ ïðèìåñü êðîâè â ìî÷å, óìåðåííîå óõóäøåíèå êà÷åñòâà ìî÷åèñïóñêàíèÿ. Ïàöèåíò æåíàò, äåòåé íå èìååò, â êà÷åñòâå êîíòðàöåïöèè ïðèìåíÿåò áàðüåðíûå ìåòîäû. Ïî ïîâîäó ïðèìåñè êðîâè â ñïåðìå íå îáñëåäîâàëñÿ, ê âðà÷àì íå îáðàùàëñÿ, ñâÿçûâàÿ èìåþùååñÿ ñîñòîÿíèå ñ ôèçè÷åñêîé íàãðóçêîé. Èç àíàìíåçà èçâåñòíî, ÷òî â äåòñêîì âîçðàñòå áûë ïîñòàâëåí äèàãíîç àïëàçèè ïðàâîé ïî÷êè. Ïðè ïðîõîæäåíèè ïëàíîâîãî ìåäèöèíñêîãî îñìîòðà ïðè ÓÇÈ âûÿâëåíî îáðàçîâàíèå â ìî÷åâîì ïóçûðå. Ó÷èòûâàÿ íàëè÷èå èìåâøåé ìåñòî ïðèìåñè êðîâè â ìî÷å è ñïåðìå, âðà÷îìóðîëîãîì ðàéîííîé ïîëèêëèíèêè áûë ïîñòàâëåí ïðåäâàðèòåëüíûé äèàãíîç îïóõîëè ìî÷åâîãî ïóçûðÿ. Ïàöèåíò êîíñóëüòèðîâàí â êëèíèêå óðîëîãèè ÌÃÌÑÓ. Ïðè òðàíñàáäîìèíàëüíîì ÓÇÈ â ïîëîñòè ìî÷åâîãî ïóçûðÿ îïðåäåëÿëîñü îêðóãëîå îáðàçîâàíèå ñ ÷åòêèìè êîíòóðàìè, èìåþùåå æèäêîñòíûé êîìïîíåíò. Ïðè ÊÒ îðãàíîâ ìî÷åâûäåëèòåëüíîé ñèñòåìû äèàãíîç àïëàçèè Ðèñ. 1. ÌÐÒ ïàöèåíòà À., 32 ãîäà Ïîäïèñíîé èíäåêñ 72075 ÓÐÎËÎÃÈß ïðàâîé ïî÷êè áûë ïîäòâåðæäåí, â ïðîåêöèè ïðàâîãî ñåìåííîãî ïóçûðüêà âûÿâëåíà êèñòà äèàìåòðîì 25 ìì ñ ÷åòêèìè êîíòóðàìè, ñîäåðæàùàÿ æèäêîñòíûé êîìïîíåíò (ðèñ. 2). Êëèíè÷åñêèé ïðèìåð № 3 Ïàöèåíò Ñ., 20 ëåò, ïðè ïîñòóïëåíèè â êëèíèêó óðîëîãèè ÌÃÌÑÓ ïðåäúÿâëÿë æàëîáû íà ó÷àùåííîå ìî÷åèñïóñêàíèå, ïåðèîäè÷åñêóþ áîëü â ìîøîíêå è ïðîìåæíîñòè, áîëåçíåííîå ñåìÿèçâåðæåíèå. Ïàöèåíò õîëîñò, äåòåé íå èìååò, ïîëîâóþ æèçíü íå âåäåò. Èç àíàìíåçà èçâåñòíî, ÷òî âûøåîïèñàííûå æàëîáû áåñïîêîÿò íà ïðîòÿæåíèè ãîäà. Ïðè àìáóëàòîðíî âûïîëíåííîé ÌÑÊÒ îðãàíîâ ìî÷åâûäåëèòåëüíîé ñèñòåìû âûÿâëåíà àïëàçèÿ ëåâîé ïî÷êè, ïî äàííûì ÓÇÈ â ïðîåêöèè ëåâîãî ñåìåííîãî ïóçûðüêà âûÿâëåíà êèñòà îáúåìîì îêîëî 20 ñì3, ïðè ýêñêðåòîðíîé óðîãðàôèè â ïðîåêöèè ìî÷åâîãî ïóçûðÿ îòìå÷àëñÿ äåôåêò íàïîëíåíèÿ, ×ËÑ ïðàâîé ïî÷êè êîíòðàñòèðîâàíà (ðèñ. 3). Ñ áîëüíûìè ïðîâåäåíà áåñåäà îòíîñèòåëüíî èìåþùåãîñÿ çàáîëåâàíèÿ è ñóùåñòâóþùèõ ìåòîäîâ ëå÷åíèÿ. Ïàöèåíòû íàñòàèâàëè íà êîíñåðâàòèâíîì ëå÷åíèè. Ó÷èòûâàÿ óìåðåííî âûðàæåííûå êëèíè÷åñêèå ïðîÿâëåíèÿ, à òàêæå îòñóòñòâèå êàêèõ-ëèáî èçìåíåíèé ñî ñòîðîíû ëàáîðàòîðíûõ àíàëèçîâ (âêëþ÷àÿ ãîðìîíàëüíûé) è ñïåðìîãðàììû, ïðèíÿòî ðåøåíèå âûïîëíèòü ïóíêöèþ êèñò ñåìåííûõ ïóçûðüêîâ ïîä ìåñòíîé àíåñòåçèåé ïîä êîíòðîëåì ÒÐÓÇÈ. Ðèñ. 2. ÊÒ ïàöèåíòà Â., 42 ãîäà; ñòðåëêîé óêàçàíà êèñòà ñåìåííîãî ïóçûðüêà, ïðîëàáèðóþùàÿ â ïîëîñòü ìî÷åâîãî ïóçûðÿ 53 ÂÑÅÐÎÑÑÈÉÑÊÈÉ ÌÅÆÄÈÑÖÈÏËÈÍÀÐÍÛÉ ÌÅÄÈÖÈÍÑÊÈÉ ÆÓÐÍÀË Ðèñ. 3. Ýêñêðåòîðíàÿ óðîãðàôèÿ ïàöèåíòà Ñ., 20 ëåò  õîäå ìàíèïóëÿöèè ó ïàöèåíòîâ À., Â. è Ñ. ïîëó÷åíî ïî 30, 25 è 15 ìë æèäêîñòè «øîêîëàäíîãî» öâåòà, ñîîòâåòñòâåííî.  êàæäîì ñëó÷àå àñïèðèðîâàííàÿ æèäêîñòü áûëà îòïðàâëåíà íà áàêòåðèîëîãè÷åñêèé ïîñåâ è öèòîëîãè÷åñêîå èññëåäîâàíèå, ïî äàííûì êîòîðûõ ðîñòà ìèêðîôëîðû è àòèïè÷åñêèõ êëåòîê íå âûÿâëåíî. Íà ñëåäóþùèé äåíü ïîñëå ïóíêöèè êèñòû ïàöèåíòû îòìåòèëè óëó÷øåíèå îáùåãî ñîñòîÿíèÿ, óìåíüøåíèå áîëåâîé ñèìïòîìàòèêè â îáëàñòè ïðîìåæíîñòè. Ñïóñòÿ ãîä ïàöèåíò À. ïåðåíåñ ïîâòîðíóþ ïóíêöèþ êèñòû ñåìåííîãî ïóçûðüêà. Îáúåì æèäêîñòè ïðè ïîâòîðíîé ïóíêöèè ñîñòàâèë 20 ìë. Íà ñåãîäíÿøíèé ìîìåíò ïàöèåíòû ïðîäîëæàþò íàáëþäàòüñÿ.  õîäå äèíàìè÷åñêîãî íàáëþäåíèÿ, ïðè ÒÐÓÇÈ îòìå÷åíà òåíäåíöèÿ ê ïîñòåïåííîìó ñíèæåíèþ îáúåìà êèñòû. Ñèíäðîì Öèííåðà, êàê ïðàâèëî, äèàãíîñòèðóåòñÿ â 3-é èëè 4-é äåêàäå æèçíè è ÷àñòî ñîïðîâîæäàåòñÿ áåñïëîäèåì [5]. Êèñòà ñåìåííîãî ïóçûðüêà ìîæåò áûòü èçíà÷àëüíî âðîæäåííîé èëè ðàçâèâàòüñÿ ïîñòåïåííî âñëåäñòâèå îáñòðóêöèè ñåìÿâûíîñÿùèõ ïðîòîêîâ, ïðîòåêàÿ áåññèìïòîìíî èëè ñ íåçíà÷èòåëüíûìè êëèíè÷åñêèìè ïðîÿâëåíèÿìè (áîëü â ïðîìåæíîñòè è/èëè äèçóðèÿ) [6]. Êèñòà ñåìåííîãî ïóçûðüêà ìîæåò áûòü äîñòàòî÷íî áîëüøîé ïî ðàçìåðó è âäàâàòüñÿ â ïðîñâåò ìî÷åâîãî ïóçûðÿ, ÷òî ïîçâîëÿåò âûÿâèòü åå ïðè ÓÇÈ. Îáñòðóêöèÿ íà óðîâíå ñåìÿâûíîñÿùèõ ïðîòîêîâ ÿâëÿåòñÿ ñàìîé ÷àñòîé ïðè÷èíîé ïðèîáðåòåííîé îáñòðóêòèâíîé àçîîñïåðìèè [7], ÷òî, â èòîãå, ìîæåò ïðèâîäèòü ê áåñïëîäèþ. 54 Äàííûé ôàêò ïîä÷åðêèâàåò íåîáõîäèìîñòü äåòàëüíîãî îáñëåäîâàíèÿ áîëüíûõ ñ ïîäîçðåíèåì íà ñèíäðîì Öèííåðà è ïðîâåäåíèå äèôôåðåíöèàëüíîãî äèàãíîçà ñ «ïîõîæèìè» çàáîëåâàíèÿìè. Áîëüíûì îáÿçàòåëüíî ïðîâîäÿò ÓÇÈ ìîøîíêè, êîòîðîå ïîìîãàåò âûÿâèòü ïðèçíàêè îáñòðóêöèè (ðàñøèðåíèå ñåòè ÿè÷êà, óâåëè÷åíèå ïðèäàòêà ÿè÷êà ñ êèñòîçíûìè èçìåíåíèÿìè èëè îòñóòñòâèå ñåìÿâûíîñÿùåãî ïðîòîêà). Äëÿ ïàöèåíòîâ ñ ìàëåíüêèì îáúåìîì ýÿêóëÿòà (<1,5 ìë) è ïîäîçðåíèåì íà îáñòðóêöèþ ïðîòîêà ïîêàçàíî âûïîëíåíèå ÒÐÓÇÈ â äâóõ ïðîåêöèÿõ. ÒÐÓÇÈ ìîæåò áûòü òàêæå èñïîëüçîâàíî äëÿ àñïèðàöèè ñîäåðæèìîãî ñåìåííûõ ïóçûðüêîâ [8]. Ïî ìíåíèþ áîëüøèíñòâà àâòîðîâ, êîíñåðâàòèâíàÿ ñèìïòîìàòè÷åñêàÿ òåðàïèÿ, à òàêæå äèíàìè÷åñêîå íàáëþäåíèå ÿâëÿþòñÿ ïðåäïî÷òèòåëüíûìè âàðèàíòàìè ïðè îòñóòñòâèè êëèíè÷åñêèõ ïðîÿâëåíèé çàáîëåâàíèÿ.  ñëó÷àå íåýôôåêòèâíîñòè êîíñåðâàòèâíûõ ìåòîäîâ ëå÷åíèÿ íàèáîëåå îïðàâäàííîé ÿâëÿåòñÿ õèðóðãè÷åñêàÿ òàêòèêà, â òîì ÷èñëå ñ ïðèìåíåíèåì ðîáîò-àññèñòåíöèè [9]. Íåêîòîðûå àâòîðû ñêëîíÿþòñÿ ê âûïîëíåíèþ òðàíñóðåòðàëüíîé ðåçåêöèè âûõîäíûõ îòäåëîâ ñåìÿâûáðàñûâàþùèõ ïðîòîêîâ â çîíå ñåìåííîãî áóãîðêà — îïåðàöèè TURED (transurethral resection of the ejaculatory ducts) [10], ïîä÷åðêèâàÿ, ÷òî â ñëó÷àÿõ ôóíêöèîíàëüíîé îáñòðóêöèè äèñòàëüíûõ îòäåëîâ ñåìÿâûáðàñûâàþùèõ ïðîòîêîâ îïåðàöèÿ óëó÷øàåò ïîêàçàòåëè ñïåðìîãðàììû è âûáðîñ ýÿêóëÿòà, ÷òî ìîæåò ïîëîæèòåëüíî ñêàçàòüñÿ íà ðåïðîäóêòèâíîé ôóíêöèè [11]. Ñîãëàñíî Guidelines EAU 2013 ã., àëüòåðíàòèâîé îïåðàöèè TURED ñëóæàò ìèêðîõèðóðãè÷åñêîå âûäåëåíèå ñïåðìàòîçîèäîâ èç ïðèäàòêà ÿè÷êà — îïåðàöèÿ MESA (microsurgical epididymal sperm aspiration), âûäåëåíèå ñïåðìàòîçîèäîâ èç òêàíè ÿè÷êà — îïåðàöèÿ TESE (testicular sperm extraction), àñïèðàöèÿ ñïåðìàòîçîèäîâ èç ïðîêñèìàëüíîé ÷àñòè ñåìÿâûíîñÿùåãî ïðîòîêà, èç ñåìåííûõ ïóçûðüêîâ ïîä êîíòðîëåì ÓÇÈ è ïðÿìàÿ àñïèðàöèÿ ñåìåííîé æèäêîñòè èç êèñòû [12]. Ñèíäðîì Öèííåðà — çàáîëåâàíèå, êîòîðîå íåîáõîäèìî ïîäîçðåâàòü ó ïàöèåíòîâ ìóæñêîãî ïîëà ñ àïëàçèåé ïî÷êè è äèàãíîñòèðîâàííûì îáðàçîâàíèåì â îáëàñòè ïðîåêöèè ìî÷åâîãî ïóçûðÿ.  áîëüøèíñòâå ñëó÷àåâ ñèìïòîìàìè çàáîëåâàíèÿ ÿâëÿþòñÿ ãåìàòóðèÿ, ãåìîñïåðìèÿ, ãèïîñïåðìèÿ, íàðóøåíèå ýÿêóëÿöèè, à òàêæå äèñêîìôîðò â ïðîìåæíîñòè ïîñëå ýÿêóëÿöèè. Ñîâðåìåííûå ìåòîäû âèçóàëèçàöèè, òàêèå êàê ÌÐÒ, ÊÒ è www.terramedica.spb.ru ÓÐÎËÎÃÈß TERRA MEDICA® № 2/ 2014 ÒÐÓÇÈ, ñïîñîáñòâóþò ðàííåé äèàãíîñòèêå ñèíäðîìà Öèííåðà. Íà÷èíàòü ëå÷åíèå öåëåñîîáðàçíî ñ êîíñåðâàòèâíîé òàêòèêè, îäíàêî òîëüêî õèðóðãè÷åñêîå ëå÷åíèå ÿâëÿåòñÿ åäèíñòâåííîé òàêòèêîé äëÿ èçáàâëåíèÿ ïàöèåíòà îò èìåþùèõñÿ æàëîá è ïðîôèëàêòèêè áåñïëîäèÿ. Ïðè îòñóòñòâèè êàêèõ-ëèáî æàëîá ñî ñòîðîíû îðãàíîâ ìî÷åâûäåëèòåëüíîé ñèñòåìû ïàöèåíòàì ïðåäïî÷òèòåëüíî íàçíà÷àòü ñèìïòîìàòè÷åñêóþ òåðàïèþ.  íàñòîÿùåå âðåìÿ ëàïàðîñêîïè÷åñêàÿ è ðîáîòàññèñòèðîâàííàÿ ìåòîäèêè ïîñòåïåííî çàìåíÿþò îòêðûòûå õèðóðãè÷åñêèå âìåøàòåëüñòâà.  íàøåì èññëåäîâàíèè ïðåäñòàâëåíû ñîáñòâåííûå ðåçóëüòàòû äèàãíîñòèêè è ëå÷åíèÿ ïàöèåíòîâ ñ ñèíäðîìîì Öèííåðà. Ó÷èòûâàÿ ìèíèìàëüíûå êëèíè÷åñêèå ïðîÿâëåíèÿ çàáîëåâàíèÿ, ïðèíÿòî ðåøåíèå î ñèìïòîìàòè÷åñêîé òåðàïèè è äèíàìè÷åñêîì íàáëþäåíèè çà ïàöèåíòàìè. Ëèòåðàòóðà 1. Parsons R. B., Fisher A. M., Bar-Chama N. et al. MR Imaging in male infertility // Radiographics. 1997. Vol. 17. P. 627–637. 2. Zinner A. Ein fall von intravesikaler Samenblasenzyste // Wien. med. Wschr. 1914. Bd. 64. S. 605–609. 3. Sheih C. P., Hung C. S., Wei C. F. Cystic dilatations within the pelvis in patients with ipsilateral renal agenesis or dysplasia // J. Urol. 1990. Vol. 144. P. 324–327. 4. Casey R. G., Stunell H., Buckley O. A unique radiological pentad of mesonephric duct abnormalities in a young man presenting with testicular swelling // J. Radiol. 2008. Vol. 81. P. 93–96. 5. Livingston L., Larson C. R. Seminal vesicle cyst with ipsilateral renal agenesis // AJR. Amer. J. Roentgenol. 2000. Vol. 175. P. 177–180. 6. Cihan A., Cimen S., Secil M. Congenital seminal vesicle cyst accompanying ipsilateral renal agenesis and rudimentary ureter // Int. Urol. Nephrol. 2006. Vol. 38. P. 133–135. 7. McVicar C. M., O´Neill D. A., McClure N. Effects of vasectomy on spermatogenesis and fertility outcome after testicular sperm extraction combined with ICSI // Hum. Reprod. 2005. Vol. 20(10). P. 2795–2800. 8. Jarow J. P. Seminal vesicle aspiration of fertile men // J. Urol. 1996. Vol. 156(3). P. 1005–1007. 9. Altobelli E., Bove A. M., Falavolti C. Robotic-assisted laparoscopic approach in the treatment for Zinner’s Syndrome associated with ipsilateral megaureter and in-complete double-crossed ectopic ureter // Int. Urol. Nephrol. 2013. Vol. 45(3). P. 635–638. 10. Pace G., Galatioto G. P., Gualà L. Ejaculatory duct obstruction caused by a right giant seminal vesicle with an ipsilateral upper urinary tract agenesia: an embryologic malformation // Fertil. and Steril. 2008. Vol. 89(2). P. 390–394. 11. Fisch H., Lambert S. M., Goluboff E. T. Management of ejaculatory duct obstruction: etiology, diagnosis, and treatment // Wld J. Urol. 2006. Vol. 24(6). P. 604–610. 12. Jungwirth A., Diemer T., Dohle G. R. et al. EAU Guidelines on Male Infertility, 2013. P. 24–28. A. O. Vasilyev, A. V. Govorov, K. B. Kolontarev, U. A. Kupriyanov, D. U. Pushkar Moscow State University of Medicine and Dentistry named after A. I. Evdokimov Zinner´s syndrome: description of the clinical cases Zinner’s syndrome — a congenital condition characterized by the presence of seminal vesicle cysts in combined with ipsilateral renal aplasia and obstruction of the vas deferens. This is a rare urological anomaly of development often characterized by asymptomatic and leads to infertility. In some cases, patients concerned pain in the scrotum and perineum, painful ejaculation, gemospermiya, dysuria. Most patients Zinner’s syndrome detected in puberty by random findings in the survey. Modern imaging techniques contribute to the early diagnosis of disease and prevention of infertility. Symptomatic therapy, and dynamic monitoring in the absence of clinical manifestations are the preferred treatment options. In the absence of the effectiveness of conservative therapy the surgical treatment by open or laparoscopic (robot-assisted) access is recommended. Early detection and treatment of the Zinner’s syndrome improves the semen that enables patients to implement reproductive function. In this paper, we describe 3 cases of congenital anomalies (cysts) of the seminal vesicles in patients 20, 32 and 42 years in combined with ipsilateral renal aplasia. Key words: Zinner´s syndrome, seminal vesicle cyst, aplasia of the kidney Ïîäïèñíîé èíäåêñ 72075 55