Epididymal Cyst

Definition/diagnostic criteria An epididymal cyst, also referred to as a spermatocele when containing sperm, is a fluid-filled sac that develops in the epididymis. These cysts are benign and usually painless, often detected incidentally during a physical examination or self-examination.

Epidemiology Epididymal cysts are relatively common. They can occur at any age but are most prevalent in adults aged 20 to 40 years. Their incidence increases with age, and they are often bilateral.

Diagnosis
Clinical features: Patients with an epididymal cyst typically present with a painless, smooth, round swelling in the scrotum. The cysts may vary in size and are generally palpable above the testicle. Discomfort, if present, is usually due to the size of the cyst. In some cases, patients may experience a feeling of heaviness in the scrotum.

Investigations: Diagnosis is primarily clinical, based on history and physical examination. An ultrasound may be performed to confirm the diagnosis and rule out other conditions like hydrocele or testicular cancer. Ultrasound findings typically show a well-defined, anechoic, fluid-filled structure adjacent to the epididymis. Transillumination of the cyst may also aid in diagnosis, where light passes through the fluid-filled cyst, confirming its cystic nature.

Treatment Most epididymal cysts do not require treatment unless they cause discomfort or are aesthetically concerning for the patient. The mainstay of management is reassurance and observation. For symptomatic cysts or those increasing in size, options include:

• Conservative: Advise scrotal support and analgesics for pain relief.
• Surgical: Spermatocelectomy or epididymectomy is considered for large, symptomatic cysts. Surgery is usually performed as a day case under local or general anaesthesia.

Aspiration and sclerotherapy are alternative treatments but less commonly used due to higher recurrence rates. Antibiotics are not indicated unless there is evidence of concurrent infection.

Prognosis Epididymal cysts have a benign course. They are unlikely to cause complications and do not affect fertility unless very large or multiple cysts distort the epididymal duct. Postoperative outcomes are generally good, with a low risk of recurrence following surgical excision.