Cysts connected with the epididymis

Epididymal cysts

These are filled with a crystal-clear fluid (as opposed to the barley-water fluid of a spermatocele or the amber fluid of a hydrocele). They are very common, usually multiple and vary greatly in size at presentation. They represent cystic degeneration of the epididymis.

Clinical features

Cysts of the epididymis are usually found in middle age and the condition is often bilateral. The clusters of tense thin-walled cysts feel like a tiny bunch of grapes on palpation. They should be brilliantly transilluminable. The presence of a scrotal mass should always raise the possibility of a testicular neoplasm. Epididymal cysts are almost always quite separate from the testis proper and this is a reassuring sign.

Treatment

Aspiration is useless because the cysts are multilocular. If they are causing discomfort they should be excised. The man should be warned that excision may interfere with the export of sperms from the testis on that side.

Cyst of a testicular appendage

Cyst of a testicular appendage is usually unilateral and is felt as a small globular swelling at the superior pole. Such cysts are liable to torsion and should be removed if they cause symptoms.

Spermatocele

This is a unilocular retention cyst derived from some portion of the sperm-conducting mechanism of the epididymis.

Clinical features

A spermatocele nearly always lies in the head of the epididymis above and behind the upper pole of the testis. It is usually softer and laxer than other cystic lesions in the scrotum but like them it transilluminates. The fluid contains spermatozoa and resembles barley water in appearance. Spermatoceles are usually small and unobtrusive. Less frequently they are large enough to make the patient think that he has three testicles.

Treatment

Small spermatoceles can be ignored. Larger ones should be aspirated or excised through a scrotal incision.