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

Spermatocoele

Unilocular retention cyst derived from some portion of the sperm-conducting mechanism of the epididymis
Typically lies in epididymal head - above and behind upper pole of testis
Usually softer and laxer than other cystic lesions in the scrotum, but still transilluminates
Fluid resembles barley water - contains spermatozoa
Excise if large and causing discomfort only