Epididymal cyst

Epididymal cysts usually develop in adults around the age of 40. Epididymal cysts are rare in children and when they occur, usually present around puberty. Cysts are found in as many as 30% of asymptomatic patients having scrotal ultrasound for other reasons.The prevalence in the general population is difficult to estimate. Patients usually present having noticed a lump. Often cysts are multiple and may be bilateral. Small cysts are tolerated by patients. However, once cysts get large they are more likely to need removal. They arise in the epididymis, the testis is palpable quite separately from the cyst.They can readily be distinguished from testicular tumours which arise from the testis. Scrotal ultrasound will assist diagnosis if there is uncertainty. Aspiration of fluid may be helpful but is rarely useful or necessary from either a diagnostic or treatment perspective.

Associated diseases:
  • Cystic fibrosis. Congenital absence of the vas deferens is the most common genital tract anomaly in cystic fibrosis (99%of patients). Epididymal cysts are common.
  • Von Hippel-Lindau syndrome. Along with other more significant manifestations of this syndrome, epididymal cysts are associated with the condition. It is a rare disease and important to recognise early.
  • Maternal exposure to diethylstilboestrol.
  • Polycystic kidney disease (autosomal dominant).

 

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Treatment

Belowis a list of treatments thatare the most effective. Evidence suggests that doctors should favour these treatments. The list can be used as the basis of a second opinion to check that your doctor's advice is sound.

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  1. Cysts can be surgically excised if large or symptomatic (painful). In children most epididymal cysts involute with time.

  2. Treatment by sclerotherapy such as tetracycline, phenol, sodium tetradecyl sulphate, polidocanol and ethanolamine oleate.

  3. Torsion of the cyst can occur but is extremely rare with only a handful of cases reported.

     

 

Conclusions

Don't forget to consider polycystic kidney disease