Appendiceal cyst

An epididymal cyst (medically known as spermatocele) is a type of seminal cystic neoplasm containing a liquid substance in the internal cavity.

This tumor is benign, but at the same time it is no less dangerous: this disease should be taken seriously.

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Causes of Epididymal Cyst

There are several reasons and options for the development of a cyst of the epididymis:

• A cyst of the epididymis may form before birth as a result of certain defects during the period of intrauterine growth of the embryo (for example, non-fusion of the paramesonephric duct). Cysts of this type contain fluid in their cavity that is devoid of spermatozoa;
• The formation of an epididymal cyst in 40% of cases may be preceded by traumatic lesions of the scrotum, infectious and inflammatory processes in the genital area, which lead to the adhesion of one or two vas deferens. As a result, the exit of seminal fluid is blocked, and male reproductive cells accumulate in the lumen of the canal. The walls of the canal, accordingly, stretch, and a cyst is formed, containing in its cavity accumulated seminal fluid with neutral or alkaline activity.

In addition to spermatozoa, lipid cells, leukocytes, and particles of epithelium, which line the walls of the cystic cavity, can be found in the cyst contents.

Epididymal cyst in men

A testicular epididymis cyst in men is a benign neoplasm.

The appendage itself is a long narrow channel that serves for the development, accumulation and movement of spermatozoa. It also produces the fluid necessary for the maturation and motor activity of male reproductive cells. Under normal conditions of a healthy male body, the sperm outlet channels should be systematically emptied, but with certain disorders, the appendage is filled with seminal fluid, and a cystic formation with a capsular connective tissue membrane appears in it.

Further enlargement of the cyst causes excessive pressure on the vas deferens of the epididymis, which disrupts the normal outflow of seminal fluid. This fact can cause reproductive dysfunction in men.

An appendage cyst most often develops in adolescence, progressing and developing over time. The peak of development occurs at the age of 30-40, and by the age of 50, a full clinical picture of the disease is already observed, which can affect about 30% of the general male population.

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Symptoms of Epididymal Cyst

Clinical symptoms of an epididymal cyst usually appear in the late stages of the development of the pathological process; in other cases, the disease generally does not manifest itself in any way, but is discovered by chance during self-examination or preventive examinations.

An epididymal cyst is usually small in size, about 2-5 centimeters in diameter, and causes virtually no discomfort to the patient.

By palpation, a spherical, mobile, smooth-elastic and practically painless tumor can be detected in any area of the epididymis or in the spermatic cord. Sometimes an illusion of the presence of a supposedly "third testicle" is created.

Sometimes the cyst may have a persistent tendency to increase, in some cases manifesting itself as significant and constant nagging pain, especially during physical activity or sexual intercourse. The formation can increase so much that it often causes discomfort during walking, sitting, motor activity, as well as a feeling of pressure and heaviness in the scrotum and perineum.

In severe, advanced cases, suppuration, inflammatory and congestive processes may develop.

Cyst of the left testicular appendage

The normal physiological structure of the scrotum is two-chambered, each of the chambers contains the testicle, its appendage and the initial section of the spermatic cord. On the left side, the testicle is usually heavier and is located slightly lower than on the right side, but this does not affect their functional capabilities in any way.

An epididymal cyst can develop on either the left or right side, and sometimes on both sides.

The left epididymis cyst is a relatively common retention cyst. Most often, it is formed from the appendage head and has the property of close adhesion to the epididymis, or is located on a stalk. This formation has high mobility and is located behind the testicle, slightly above it. When the cystic tumor becomes noticeable, it is often confused with ovarian dropsy (hydrocele).

A cyst of the left testicular appendage can appear at absolutely any age, it is discovered by chance. If diagnosed correctly, it does not pose a danger to the body.

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Right epididymal cyst

The right testicle is anatomically located higher than the left and is often slightly smaller in size, which is associated with reduced blood supply to the right side.

A cyst of the right epididymis may appear both in men of reproductive age and much later. It is most often found in physically active young people, as a result of increased stress and frequent trauma to the perineal area.

The clinical picture of an appendage cyst is not always directly proportional to its size. Sometimes tiny cystic formations 3-4 mm in diameter, located in the head of the appendage, can contribute to the appearance of pulling painful sensations, and large tumors with dislocation in the tail part of the appendage or along the spermatic cord are characterized by a sluggish asymptomatic course.

Cysts can be located singly or multiple times and are palpated on the back of the testicle, separately from it.

The progressive growth of the cyst of the right ovarian appendage provokes an increase in the size of the right scrotum, which makes it possible to detect the existing pathology.

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Cyst of the head of the epididymis

A cyst of the head of the epididymis is a voluminous spherical benign neoplasm located in the scrotum above the testicle area and representing a dense fibrous capsule with internal contents of seminal fluid. The head of the epididymis area is the most common localization of cystic neoplasms of the testicle. Sometimes even small cysts formed in the head of the epididymis area can provoke periodic nagging pain and a feeling of heaviness and pressure in the scrotum or perineum. Such a cyst must be shown to a specialist for differential diagnosis with other possible neoplasms in the testicle area.

With a calm, uncomplicated course, this cystic formation, as a rule, does not pose a particular danger to the functional abilities of a man; it has a smooth surface, a spherical shape, a dense elastic consistency and is visible through transmitted light, which is a significant difference between a cyst of the head of the appendage and other neoplasms.

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Diagnosis of epididymal cyst

Diagnosis of an ovarian appendage cyst is carried out primarily on the basis of the clinical picture, characteristic complaints of the patient and the results of a palpation examination: the contours of a cystic, dense elastic formation are palpated in the scrotum.

Additional diagnostic methods – diaphanoscopic and ultrasound examination of the scrotum – allow for definitive confirmation of the correct diagnosis.

Diaphanoscopic examination is the use of a directed beam of transmitted illumination. The structure of the appendage cyst is able to transmit light perfectly, so during transillumination the size of the tumor and the color of its contents are clearly visible.

Ultrasound examination of the scrotum is the most common method of cyst diagnostics. It allows detecting and differentiating the cyst, determining its size, contours, and wall thickness.

Magnetic resonance imaging or computed tomography is a method that is no longer used to diagnose an appendage cyst, but to differentiate it from more serious tumor processes.

Very rarely, a cyst puncture may be prescribed to determine the nature of the contents in its cavity.

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Treatment of epididymal cyst

Appendageal cysts, characterized by an asymptomatic course and non-critical size, do not require urgent therapeutic measures: a wait-and-see approach can be applied to them.

Sclerotherapy is now practically not used for treating cysts due to the increased risk of recurrence of the disease, as well as the risk of disruption of spermatogenesis: this method can only be offered to those men who no longer want to have children in the future. The essence of this procedure is the extraction of the seminal substance from the cystic cavity and the introduction of a certain sclerosing substance instead, which allows gluing the walls of the cyst and preventing further accumulation of fluid in it.

The method of electrocoagulation is quite new and quite popular. Relapses after such treatment are rare, and the recovery period is minimal.

Folk remedies for getting rid of an appendage cyst are often used, but their effectiveness and safety have not been scientifically proven. Here are some examples of folk recipes:

• brew a tablespoon of common cocklebur with a glass of boiling water and take two tablespoons 4-5 times a day;
• brew a teaspoon of sage leaves in a glass of boiling water, take two tablespoons up to 4 times a day;
• A teaspoon of mountain arnica is infused in a glass of boiling water, and a tablespoon of the infusion is taken up to 4 times a day.

However, to this day, the most radical method of treatment remains surgical intervention.

Removal of epididymal cyst

Surgical treatment involves the use of local or general anesthesia and requires temporary hospitalization. The recovery period after surgery, in the absence of complications, is about 10 days.

The technique of the operation to remove the cyst of the epididymis is as follows: a small incision is made with a scalpel along the longitudinal suture of the scrotum, through which the testicle is removed, then the cyst is carefully excised and enucleated, trying not to damage it under any circumstances. After this, the testicle is carefully tucked back in, followed by careful suturing of the wound. The stitches must be applied with jewelry care to prevent future cicatricial changes in the tissues, which will certainly affect the process of formation and movement of spermatozoa. The removed formation must be subjected to histological examination. The stitches are usually removed after a week.

A month after the operation, it is recommended to visit the urologist again for a repeat preventive examination.

Prevention of epididymal cysts

Unfortunately, there are no preventive measures against congenital anomalies in the development of the epididymis that provoke the appearance of cysts.

To prevent the development of an acquired cyst, it is necessary to limit the influence of risk factors: avoid trauma to the perineal organs (even a microtrauma to the testicle can contribute to the formation of a cystic formation), promptly treat infectious and inflammatory diseases of the testicles, urethra, prostate gland, and avoid prolonged low- and high-temperature effects on the genitals. It is also recommended to protect yourself from sexually transmitted infections: it is important to use a condom during casual sex.

If an unknown dense formation is detected in the scrotum or if there is a characteristic clinical picture of the disease, it is necessary to consult a urologist and undergo the appropriate examination. Early detection of the tumor facilitates effective treatment and reduces the risk of complications.

Epididymal Cyst Prognosis

The prognosis and expected outcome of the operation to remove the cyst of the epididymis are very favorable. Radical removal of the formation is considered the best therapeutic method for solving this pathological problem. About 95% of operated patients report improved spermatogenesis and relief from periodic pain in the scrotum.

The prognosis after the sclerotherapy procedure is much less optimistic: various complications may occur, such as a chemical inflammatory process leading to compaction of the scrotal tissue, reproductive dysfunction, recurrence of the cyst, and infection.

In principle, there is a risk of damage with any procedure, especially if it is a surgical intervention. Therefore, it is important to choose a qualified urologist to avoid possible serious damage to the appendage.

However, the overall prognosis of the disease is quite favorable. The pain goes away after treatment, the cosmetic problem is solved, and the man's reproductive function returns to normal.

Be attentive to yourself and your health, pay attention to the appearance of new growths in your body, even if it is an asymptomatic tumor such as an appendage cyst.