Editing Epididymal cysts (section)

== Epididymal cysts ==

* Common, usually found in middle age
* Usually multiple at presentation, often bilateral
* Filled with crystal-clear fluid
* Represent cystic degeneration of epididymis
* Examination
** Feels like a tiny bunch of grapes posterior to, and quite separate from, the testis
** Should transilluminate brilliantly
* Investigation
** Confirm diagnosis with ultrasound
* Treatment
** Aspiration is useless - too many, and multilocular
** If causing discomfort can be excised
** Usually requires partial or total epididymectomy
** High risk of problem with fertility (on that side at least)
* Excision of epididymal cysts
** Relatively contraindicated in young men - may affect fertility
** Incise scrotal skin as for hydrocoelectomy and deliver testis with appendages
** Cysts are often multiple, seen at upper pole
** Use scissors to completely excise the cyst, or de-roof it
** If there are lots of cysts, excise that part of the epididymis
** Oversew the raw area left
** Return the testis and close in layers