Testicular cysts in men are benign neoplasms of the genital organs and rarely undergo malignancy.. More common in young and middle-aged people. The lesion is unilateral (only the right or left egg). With injuries, a paired nature of formations can occur..

The manifestations of cystic testicular neoplasms depend on their anatomical location.

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Definition.

Character.

Spermatocele.

Epididymis cyst in men.

It is a cavity that is filled with serous fluid and covered with a connective tissue membrane. Often comes from the head of the appendage and may have a stalk. Depending on the origin, it can be congenital and acquired (a consequence of trauma, inflammation).

funiculocele.

Cyst of the spermatic cord.

The disease is also represented by a cavity, which is delimited by a connective tissue or fibrous membrane.. Degeneration into fibrous tissue occurs with frequent injury (the reason is sports injuries).

Treatment is based on detection. The exception is children under 6 months of age, in which case expectant management up to a year is indicated..

Symptoms of a testicular cyst in menManifestations will depend on the type of formation, which is associated with the peculiarity of the structure of the anatomical structures.

Epididymis cyst Clinical manifestations of cystic neoplasms of the epididymis (epididymis) will depend on their location (head of the epididymis, body or tail). In accordance with this, the same size of formations can give an extremely different clinical picture.. Typical symptoms:.

The patient discovers the formation by chance when performing hygienic measures (typically for localization of the tail).

Pain that radiates to the groin area. Pain of varying intensity occurs if the formation is localized in the head of the appendage.

Compression of the vas deferens, which leads to a violation of the excretion of spermatozoa and the development of male infertility. At the initial stages, there are problems with conception, but as such, infertility is not diagnosed, since the function of the testicles is not impaired.

Deformation and enlargement of the scrotum. Since the neoplasm affects one testicle, there is a clear asymmetry of the tissues. There is no hyperemia. Edema is insignificant.

It is palpable as a densely elastic formation, therefore, it is incorrect to make a diagnosis only with the help of a physical examination (in the photo, any option, regardless of location, looks the same).

Cyst of the spermatic cord The occurrence of symptoms depends on the size of the formation (up to 2 cm are not clinically manifested).

Pain in the scrotum. May radiate to groin and perineum. In this case, it is necessary to carry out differential diagnosis with strangulated inguinal-scrotal hernias..

With a significant size of the formations, difficulty urinating occurs, since in this case they occupy a large area and compress the surrounding tissues. Poor diagnostic sign, suspicion of malignancy.

The cyst in the scrotum is palpated as a densely elastic formation of a rounded shape.. Often painless. Not soldered to surrounding tissues. Surrounding tissues are not changed. Regional lymph nodes are not enlarged.

Deformation and asymmetry similar to an adnexal cyst.

It must be differentiated from malignant tumors, which in the early stages manifest similarly to cysts..

Diagnosis Diagnosis of the disease includes the following points:.

history taking (no special features);

physical examination (palpable mass in the scrotum);

laboratory and instrumental studies.

The diagnosis of a cyst is confirmed by the following methods:.

Diaphanoscopy. The method is based on the passage of light rays through the scrotum (the test is carried out in a dark room). The area of \u200b\u200bthe scrotum with cystic formation has a more pink glow, as it does not contain dense structures that darken.

Sonography, or ultrasound. Allows not only to identify the cystic cavity, but also to determine the size, contents, boundaries, condition of the surrounding tissues. Benign formations have clear contours, homogeneous contents, do not affect the surrounding tissues. There is no blood flow at the site of formation.

MRI / CT is used only in case of suspected malignancy (fuzzy contours, heterogeneous contents, metastases).

From laboratory methods, a cytological and histological examination of a remote cystic formation is distinguished.

There are no specific laboratory studies in the preoperative period that indicate the diagnosis..

Tactics of treatment of testicular cystsTreatment is carried out in a planned manner and depends on the size of the formation.

There are several tactics for managing patients with cystic neoplasms:.

With small sizes (up to 2 cm) and the absence of clinical manifestations, expectant tactics are chosen with ultrasound control every 2-3 months.

For large sizes, the operation is carried out in a planned manner. The scope of intervention depends on the characteristics of education.

If torsion, rupture, or other complications are suspected, emergency hospitalization and removal of the cystic mass are indicated..

Surgical removalPreoperative preparationPreoperative examination includes (direction for tests is issued by the urologist in a planned manner):.

general blood analysis;

general urine analysis;

determination of blood group and Rh factor;

coagulogram;

tests for HIV, syphilis and hepatitis C and B;

dentist consultation;

ECG.

In each clinic, the list of necessary tests for surgery may vary slightly..

Surgery There are several options for surgical treatment..

Treatment option.

Description.

Through open access.

Carried out under general anesthesia. A small incision is made in the area of \u200b\u200bthe scrotum. The tissues are dissected in layers and the testicle with the appendage is brought to the surface.. The cyst is excised and sent for a biopsy.. The testicle with an appendage, if necessary, is sutured and immersed in the scrotum. The wound is sutured in layers and cosmetic sutures are applied to the skin. It is possible to treat large cysts in this way, when there is no possibility of laparoscopy. Organ functions are fully preserved.

Laparoscopy.

A more modern method that is minimally invasive and is the gold standard for the treatment of small neoplasms. Special devices (video cameras, trocars) are used, which are inserted into the abdominal cavity. Cystic formations are removed from the side of the abdomen, and not from the side of the scrotum, as with open access. Usually there are no complications.

Sclerotherapy.

Is a special treatment. It is better to use in the elderly, as there is a high risk of infertility due to damage to the genital organs - testicles, epididymis, vas deferens. A needle is inserted into the cyst area, while the scrotum is fixed with the brush of the second hand, and the contents are removed. Next, a special composition is injected into the cyst cavity - a sclerosant, which provides soldering of the cyst walls.. If the drug enters the surrounding tissues, sclerosis of the seminal ducts or other anatomical structures may occur, which leads to a complete loss of organ function..

Postoperative periodIn the postoperative period, the use of a bandage and non-steroidal anti-inflammatory drugs (pain relief) is indicated. Physical activity of any nature is limited for a month (you can’t play sports, have sex).

Removal of a testicular cyst can be performed in an open or closed way, as well as with the help of sclerotherapy. Consequences The consequences and complications of cystic formations can be divided into those associated with surgery and those associated with the formation itself.. Adnexal injury. Often occurs during sclerotherapy (therefore, it is optimal to carry it out under ultrasound control).

Pain in the scrotum. The pain becomes permanent when the nerve fibers are crossed during the operation..

Infertility. Associated with the intersection and subsequent ligation of the spermatic cords. In this case, a vasectomy occurs - surgical contraception or sterilization.

Swelling and infiltration - in the first days after surgery are a normal tissue reaction. If edema persists for 5-7 days, repeated surgical intervention is indicated, since there is compression of organs (in particular, testicles), ischemia and a gradual decrease in function.

Recurrence of cysts. This happens more often when using laparoscopy than when performing an open operation, due to incomplete excision of the cyst capsule..

Consequences of long-term untreated cystic neoplasm1. Attachment of a secondary infection by hematogenous, lymphogenous or contact routes and the development of a purulent process in the tissues of the testicle. In this case, the clinic will have a vivid picture (hyperemia, edema, infiltration, sharp pain, intoxication).

Rupture of the cyst with the release of the contents into the surrounding tissues. Unlike ovarian ruptures in women, in men, the abdominal cavity is not involved in the process.. But the fluid that got into the scrotum can suppurate and provide an inflammatory process..

Decreased normal testicular function (erectile dysfunction). Reversible, occurs when cysts are 3 cm or more in size.

Infertility due to compression of the vas deferens by a cyst. Reversible with timely treatment, unlike infertility caused by incorrect surgical intervention.

Since the testicles are paired organs, clinical symptoms and complications may not occur immediately (a healthier testicle partially takes over the function of the affected one).

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