A randomised study of management modalities in epididymal cyst

Background: Epididymal cysts are common in teenagers and young adults. They can present as unilocular or multilocular swelling. These cysts are generally present on one side but can be bilateral. Small epididymal cyst are asymptomatic but are detected on ultrasound examination of scrotum. This study was done with aim of treating epididymal cyst with different modalities based on size of the epididymal cyst.Methods: A total of 124 patients of epididymal cyst were included in this study. Scrotal ultrasonography was done in these patients. The clinical presentations of these patients were asymptomatic detected on ultrasound, orchialgia, scrotal swelling and physical examination. Based on the size of epididymal cyst patients were divided into three groups. The treatment modalities used these were natural involution, aspiration, aspiration and sclerosing agent and surgical excision.Results: The group I consisted of cyst size less than 10mm having 73 patients. The group II consisted of patients with cyst size 11-20mm having 39 patients; and group III patients were with cyst size 21-50mm having 12 patients. Natural involution was most effective treatment modality in group I and group II. Aspiration was the second was most effective. Only a few patients required aspiration and sclerosing agent. Surgical excision was done in majority of group III patients and failed aspiration in group II.Conclusions: The results of present study show that asymptomatic and small epididymal cyst can be cured by natural regression in 77.42%. The cysts 11 to 20mm are amenable to aspiration alone, only a few need repeat aspiration and instillation of a sclerosing agent. These conservative approaches save the cost. Excision should be reserved for very large cysts and in which conservative approach fails.