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