Spermatocele Research Articles

Histopathological changes in testicular lesions in cats.

The aim of this retrospective study was to describe the neoplastic and non-neoplastic lesions seen on histopathological examination of cat testes in Hong Kong between 2018 and 2024. A total of 26 single or dual testes samples were collected from 18 cats by veterinarians at 14 veterinary clinics and submitted for histopathological examination. Laboratory records, including signalment, lesion location, age, breed and histopathological findings, were reviewed for each cat. Neoplastic testicular lesions were seen in three older cats (median age 8.5 years; range 3-17) compared with 18 non-neoplastic lesions in 15 cats (median age 1 year; range 0.5-3). The most common non-neoplastic lesions included inflammation (in the testes, epididymis, tunics and ductus deferens), cryptorchidism, and one case each of polyorchidism and epididymal cyst formation. Two of the testes with inflammation were identified on immunohistochemical staining as feline coronavirus-infected and one pair of testes was associated with the presence of extracellular Gram-negative bacteria at the lesion site. Three different neoplastic lesions were identified, one each of Sertoli cell tumour, leiomyoma and fibrosarcoma. Non-neoplastic testicular lesions were most common, including inflammation, cryptorchidism, polyorchidism and epididymal cysts. To our knowledge, leiomyoma and fibrosarcoma have not been reported in cat testes before and represent important differential diagnoses for testicular lesions.

Epididymal Cyst Lesions Are Not Associated With Impaired Semen Parameters Among Men Presenting for Fertility Evaluation.

Epididymal cyst lesions (ECLs) include both spermatoceles and epididymal cysts and are often incidentally found on physical exam or scrotal US (SUS). We aimed to determine the association of ECLs and semen parameters among men presenting for fertility evaluation. We reviewed men at our institution who had at least 1 semen analysis and SUS available for review between 2002 and 2022. SUS data included testicular measurements, presence or absence of subclinical varicocele, and size and laterality of ECL, if present. Demographic and clinical information including serum testosterone and follicle-stimulating hormone and semen parameters were compared between men with and without ECLs. Among 861 men, 164 (19%) had unilateral right ECL (median 4 mm, interquartile range 3-8 mm), 189 (22%) had unilateral left ECL (median 4 mm, interquartile range 3-9 mm), and 113 (13%) had bilateral ECL. Patients with ECLs were significantly older than men without ECLs at the time of evaluation but had no statistically significant difference in semen volume, sperm concentration, sperm motility, sperm morphology, total motile sperm count, or serum hormonal values. Analysis of men with unilateral and bilateral ECLs showed that ECL size and laterality did not significantly correlate with any semen parameter evaluated. We found no association between ECLs and semen parameters. Patients should be counseled toward conservative management with observation for asymptomatic ECLs in the setting of fertility evaluation.

Twist and turn of an unusual entity: A rare case report of torsion of huge epididymal cyst from a tertiary hospital

An epididymal cyst (EC) is a benign lesion. It arises due to cystic degeneration of the epididymis. The torsion of it is extremely rare. The usual presentation of the cyst is asymptomatic scrotal swelling. The swelling has a lobulated surface and feels like a bunch of grapes. The huge EC is rare and moreover, it is associated with torsion-rarest presentation.

Beyond the Incision: A Comparative Study of Suprainguinal and Inguinal Varicocele Surgeries.

Background Varicocele, characterised by the abnormal dilation of the pampiniform plexus of scrotal veins, is a prevalent and treatable cause contributing to male infertility, affecting 40% of men experiencing primary infertility and 80% of those with secondary infertility. Often asymptomatic, it can lead to chronic scrotal pain or a feeling of heaviness. Surgical interventions such as open, laparoscopic, or microsurgical varicocelectomy aim to eliminate venous reflux into the scrotum. This study sought to assess and evaluate the surgical outcomes and postoperative complications of the suprainguinal and inguinal approaches to varicocelectomy, offering evidence-based insights to improve varicocele management. Methodology A total of 60 males diagnosed with grade II or III unilateral or bilateral varicocele were included in the study. Patients with subclinical or grade I varicocele, recurrent varicocele, or concomitant inguinoscrotal pathology (hydrocele, epididymal cyst, and inguinal hernia) were excluded. Participants were randomly assigned to one of two groups based on the surgical technique: Group A (suprainguinal approach) and Group B (inguinal approach). Surgical outcomes were assessed by evaluating operating time, postoperative pain, wound hematoma, wound infection, hydrocele development, testicular atrophy, and semen analysis, both pre- and postoperatively. Results The study included 60 patients with a mean age of 29.05±5.96 years and an age range of 18-40 years. The suprainguinal approach offers a significantly shorter operating time than the inguinal approach (33.1 vs. 40.8 minutes). Both surgical techniques resulted in similar postoperative pain levels. The incidence of complications, such as wound hematoma, wound infection, and hydrocele development, showed no significant differences between the two approaches. In Group A (suprainguinal approach), the rates were 3.3%, 6.6%, and 3.3%, respectively, while in Group B (inguinal approach), they were 6.6%, 13.3%, and 6.6%. Additionally, 75% of patients in the infertility group showed improvements in semen parameters, with 80% in Group A and 71.4% in Group B, with no significant difference between the surgical approaches. Conclusion The suprainguinal and inguinal approaches to varicocelectomy effectively manage varicoceles, with the suprainguinal approach offering a shorter operating time. Postoperative complications and improvements in semen parameters were comparable between the two methods.

Epididymal cysts in children: frequency, clinical characteristics, and management strategies.

Epididymal cysts (ECs) are uncommon in the pediatric population. The objective of this study was to evaluate the frequency, clinical characteristics, and management strategies of ECs in children. We performed a retrospective review of pediatric scrotal ultrasounds between January 2014 and August 2022 to identify children with ECs. One hundred and forty-three children boys were found to have ECs, with 95 being pre-pubertal and 48 post-pubertal. The age of the patients ranged from 1 day to 18 years, with a mean age of 10.64 ± 4.55 years. The size of the cysts varied from 2 mm to 35 mm. The most common comorbidities observed were hydrocele, testicular microlithiasis and varicocele. The majority of ECs were detected through routine physical examination. Conservative management was employed for all patients, except for one who required surgical excision. Resolution of ECs occurred in 12 patients, while a reduction in cyst size was observed in 6 cases. Conversely, 2 patients experienced an increase in cyst size, and 6 patients exhibited an increase in cyst number during the follow-up period. Conservative management is the preferred approach for the majority of cases, with surgical intervention reserved for specific instances.

Large Epididymal Cyst: A Tale of Three Testes

Background: An epididymal cyst is a benign cystic structure that develops from the epididymis, typically due to a blockage in the epididymis, resulting in fluid accumulation. These cysts are generally harmless and noncancerous. Case Presentation: We examine the case of a 30-year-old male referred by the Psychiatry department for an assessment of the inguinal scrotal region, due to his belief that he had three testicles. Physical examination revealed an extratesticular, fluctuant, and cystic swelling easily palpable and distinct from the body of the left testis. Ultrasound findings showed a 2.3 x 1.7 cm fluid-filled lesion at the head of the epididymis. Intervention: Following a psychiatric evaluation, the patient underwent surgical excision of the cyst. Conclusion: The histopathological examination of the surgically removed cyst confirmed the diagnosis of an epididymal cyst, underscoring the importance of considering such benign conditions in differential diagnoses of scrotal abnormalities.

Advanced Sonographic Techniques in the Comprehensive Evaluation and Diagnosis of Male Infertility.

Background Infertility affects many couples, with male factors being responsible for over half of the cases. Male infertility can arise from various testicular illnesses, such as varicocele and cryptorchidism, as well as posttesticular disorders, like ejaculation abnormalities. Infertility is defined as the inability to conceive after 12 months of unprotected sexual activity or after six months for women over 35. Diagnostic techniques such as semen analysis and scrotal ultrasonography are done to evaluate conditions like varicocele and epididymo-orchitis. This study aims to assess the diagnostic utility of ultrasonography for male infertility and compare its findings with those from surgery and clinical care. Methodology All patients were referred to the Department of Radiology,Tertiary Care Hospital, South India, for transrectal and scrotal ultrasonography, using a high-frequency transducer with a frequency of 7.5 MHz and a color Doppler when necessary. The study included all male patients with infertility and abnormal semen analysis, as well as those with infertility accompanied by scrotal abnormalities detected during clinical examination. Patients were placed in the left lateral decubitus position for the transrectal ultrasonography examination. The testes and epididymis were thoroughly examined on both sides and compared regarding symmetry, size, texture, and vascularity. Results Varicocele was the most frequent anomaly detected by both clinical examination and ultrasonography. Ultrasound detected 30 cases of varicocele, whereas clinical examination diagnosed 15 cases. Hydrocele was identified in eight cases through clinical examination and in 15 cases through ultrasound. Epididymal cysts were found in five cases via clinical examination, while both clinical examination and ultrasonography discovered epididymitis in 10 cases. Overall, the number of anomalies detected by ultrasound was significantly higher than those found by physical examination, with a statistically significant p value of 0.001. Conclusion Transrectal ultrasound provides high-resolution imaging of the prostate, seminal vesicles, and distal vas deferens, which aids in diagnosing obstructive azoospermia. Imaging is a valuable supplement to clinical examination and laboratory studies for accurately identifying anatomy and abnormalities. Both transrectal and scrotal ultrasonography offer crucial information in diagnosing male infertility. Ultrasonography is more effective in identifying pathological abnormalities than clinical palpation.

The Clinical Management of Intrascrotal Extratesticular Masses With Evaluation of Histopathologic Findings

ObjectiveTo contribute to the literature by sharing the clinical presentation, surgical approach, postoperative complications management and follow-up protocols of the patients we operated on due to intrascrotal extratesticular mass. MethodsThirty-two patients admitted due to intrascrotal extratesticular mass were included in the study. Demographic and clinical characteristics of the patients such as age, initial clinical presentation, physical examination, radiological imaging findings such as scrotal Doppler ultrasonography and magnetic resonance imaging, mass size and characteristics, surgical treatment procedures, operation notes, and patient follow-up visits were retrospectively examined and evaluated from the patient files. ResultsThe median age of the 21 32 individuals included in the study was 52(interquartile range (IQR):[45.0-60.5]) years. The primary reason for initial presentation was a palpable mass in 25 (78.1%) patients, pain in 13 (40.6%) patients, and scrotal swelling in 8(25%) patients. The median mass diameter was 4.4 (IQR:[3.1-5.7]) cm. Surgical treatment involved inguinal excision in 29 cases (90.6%) and inguinoscrotal excision in 3 cases(9.4%). All patients were treated with testicle sparing surgery. The most common tumor location, observed in 27 cases (84.3%), was the epididymis. The most frequent histopathological diagnosis was epididymal cyst, identified in 13 patients(40.6%). Pathology results showed that the mass was removed with negative margins in all patients. ConclusionTesticular-sparing surgery through the inguinal approach is one of the surgical methods that can be preferred for intrascrotal extratesticular masses. This approach can both preserve the testicle and achieve successful surgical results. Studies with larger samples are needed on this subject. Trial registrationThis study was approved by the Erzurum Medicine Faculty University Local Ethics Committee (approval number: BAEK 2023/08-105).

A case report of a giant epididymal cyst

Epididymal cyst is commonly seen in middle aged. The pathogenesis of epididymal cyst is still unclear. Small epididymal cyst are asymptomatic but are detected on ultrasound examination of scrotum. Giant epididymal cyst is even rarer in adults and children. We present the case of a 25 year old man with giant mass in right scrotum, which was clinically diagnosed as a right epididymal cyst. An ultrasound of the scrotum revealed images supporting a giant epididymal cyst. Intraoperatively, a giant epididymal cyst was observed, for which the patient underwent its excision. Postoperatively, the patient is doing well of follow-up.

Symptomatic Intraparenchymal Epididymal Cysts: Description of 11 cases.

Epididymal cysts are benign cystic formations of the epididymis that usually appear in adolescence or early adulthood. Their frequency doubles after the age of 14-15. Obstruction in the epididymal efferent ductules with subsequent prostenotic dilatation of them, as well as dysgenesis due to hormonal disorders during fetal or postnatal life, are possible. At the 1st Department of Pediatric Surgery of A.U.Th. we treated 11 cases of boys at the age of 11-16 who presented with acute scrotum because of an epididymal cyst. The diagnosis was confirmed by ultrasound scanning . Due to persistent symptomatology, patients underwent surgical exploration and removal of the cyst. The postoperative care of the patients was uncomplicated with immediate remission of symptoms. In one case, ipsilateral acute epididymitis occurred after 10 days, which was successfully treated with antibiotic therapy. It is reported that approximately 50% of epididymal cysts involute within an average of 17 months. In conclusion, using the data obtained from the review, of the small in number of international bibliography studies, it is proposed conservative treatment of asymptomatic cysts with diameter smaller than 1 cm and surgical excision [1] of large asymptomatic cysts with diameter greater than 1 cm, which do not regress after a follow-up of 24-48 months, cysts, regardless of their diameter, responsible for persistent symptoms and in the manifestation of acute scrotal symptoms due to inflammation, intravesical bleeding or secondarily torsion of the epididymis.

(131) Microsurgical Denervation of the Spermatic Cord for Chronic Scrotal Pain: Results from a Prospective Case Series

Abstract Introduction Microsurgical spermatic cord denervation (MSCD) is one of the lines of management of chronic scrotal pain refractory to conservative lines of therapy, however, it has not been fully adopted by different centres. Other procedures such as epididymectomy, orchidectomy and vasectomy reversal are being offered instead. Objective To evaluate the safety and efficacy of microsurgical denervation of the spermatic cord in the management of chronic scrotal pain refractory to conservative lines of therapy. Methods Twenty consecutive patients were prospectively enrolled for MSCD over a 24-month period. These patients underwent MSCD after exclusion of any correctable cause of chronic scrotal pain (CSP) and/or poor response to medical treatment. Efficacy of the technique was evaluated by the degree of pain improvement using the Visual Analogue Scale (VAS). Safety was assessed by reporting any intra- or post-operative complications. Results The mean age of the studied population was 51.7 (36–78) years. The mean pain duration was 4.2 (1–20) years. In 8 patients (40%), the aetiology of the chronic pain was idiopathic, 5 patients (25%) the pain occurred after previous scrotal surgery (vasectomy in 2 patients, AUS in 2 and an epididymal cyst excision in 1 patient), 4 patients (20%) post scrotal trauma and 3 patients (15%) post epididymo-orchitis. Ten patients (50%) had complete pain resolution, 8 (40%) had a partial resolution of their pain, the pain remained the same in a one patient (5%), and one patient (5%) had resolution of the scrotal pain but developed pain at the incision site following MSCD. The VAS pain score significantly improved from a mean of 9.7 to 3.7 postoperatively. (p=0.0029). No significant complications have been encountered in this case series. Conclusions Microsurgical denervation of the spermatic cord is a safe and reliable option that should be more widely adopted to treat men with chronic scrotal pain refractory to conservative treatment. Disclosure No.

Outcomes after chronic isolated epididymal pain A retrospective study.

Despite being a commonly encountered urologic condition, there remains a paucity of understanding and literature on the management and natural history of isolated epididymal pain. Typically, patients who do not respond to conservative management undergo an epididymectomy; however, the literature on its efficacy is also scarce, with success rates varying from 10-90%. Our goal was to better describe the etiology and natural history of isolated epididymal pain and to describe the rates of success associated with epididymectomy. A retrospective, case-control study was conducted at the Manitoba Men's Health Clinic, with the approval of the University of Manitoba Research Ethics Board. All patients presenting with chronic epididymitis, defined as discomfort or pain localized to the epididymis for at least three months, were identified. Information regarding patient demographics, past medical and surgical history, duration of pain, localization of pain, findings on previous ultrasounds, prior conservative therapies trialed, and response rates, as well as response rates to surgical therapy were collected. From April 2022 to April 2023, a total of 275 patients with chronic orchialgia were identified; among them, 74 patients presented with chronic isolated epididymal pain. On average, 22.9% of patients experienced symptoms for 3-6 months, 10% for 6-12 months, and 67.1% for over 12 months; 13.5% (n=10) had associated ejaculatory pain, 8.1% (n=6) had lower urinary tract symptoms, and 4.1% (n=3) had erectile dysfunction. Ultrasound findings were observed in 68.9% of patients, with 31.1% having an epididymal cyst, 27.1% having a varicocele, 5.4% having a spermatocele, and 4.1% having a hydrocele. Among those who underwent conservative therapy, only 36.2% of patients reported a positive response. Surgical intervention was performed on 23 patients, including 16 who underwent epididymectomy, three who underwent cord denervation, and two who underwent vasovasostomy and spermatocelectomy each. Most (81.3%, n=13) patients who underwent epididymectomy had a positive response to the surgical intervention, defined as no pain on followup, while all patients undergoing other surgical interventions experienced a positive response. Chronic epididymal pain is a condition with limited data surrounding its management. Prior to referral, a large proportion of patients did not undergo any conservative treatment, and of those that did, there was limited response. For those who underwent surgical intervention, all were pain-free on followup, except three patients who underwent epididymectomy.

(080) Outcomes After Isolated Epididymal Pain

Abstract Introduction Chronic epididymitis imposes significant physical and psychosocial distress on affected patients. Despite being a commonly encountered urologic condition, there remains a paucity of understanding and literature surrounding the management and natural history of isolated epididymal pain. Typically, patients who do not respond to conservative management undergo an epididymectomy. However, the literature on its efficacy is also scarce, with success rates varying widely from 10-90% in existing studies. Objective To better describe the etiology, pathogenesis and natural history of isolated epididymal pain. Furthermore, we aimed to describe the rates of success associated with epididymectomy. Methods A retrospective cohort study was conducted at the Manitoba Men’s Health Clinic, with approved by the University of Manitoba REB. All patients presenting with chronic epididymitis, defined as discomfort or pain localized to the epididymis for at least three months, were identified. Information regarding patient demographics, past medical and surgical history, duration of pain, localization of pain, findings on previous ultrasounds, STI testing results, prior conservative therapies trialed and response rates, as well as response rates to surgical therapy were collected. Results From April 2022 to 2023, a total of 274 patients with chronic orchialgia were identified, and among them, 74 patients specifically presented with chronic isolated epididymal pain. The average duration of symptoms was as follows: 21.6% (n=16) of patients experienced symptoms for 3-6 months, 9.5% (n=7) for 6-12 months, and 63.5% (n=47) for over 12 months. 13.5% (n=10) had associated ejaculatory pain, 8.1% (n=6) had lower urinary tract symptoms, and 4.1% (n=3) had erectile dysfunction. Ultrasound findings were observed in 68.9% of patients, with 31.1% having an epididymal cyst, 27.1% having a varicocele, 5.4% having a spermatocele, and 4.1% having a hydrocele. 49.4% (n=40) did not undergo any intervention prior to referral. After referral, 58.8% (n=43) of patients had undergone antibiotic treatment, 12.2% (n=9) had tried an NSAID, and one patient was referred for pelvic floor physical therapy. Among those who underwent conservative therapy, only 36.2% of patients reported a positive response. Surgical intervention was performed on 23 patients, including 16 who underwent an epididymectomy, three who underwent cord denervation, and two who underwent vasovasostomy and spermatocelectomy each. 81.3% of patients (n=13) who underwent an epididymectomy had a positive response to the surgical intervention, defined as satisfactory improvement of pain, while all patients undergoing other surgical interventions experienced a positive response. Conclusions Chronic epididymal pain is a condition with limited data surrounding its management. Prior to referral, a large proportion of patients did not undergo any conservative treatment, and of those that did, there was limited response rates. For those who underwent surgical intervention, all were pain free on follow up, except three patients who underwent and epididymectomy. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.

(206) Novel Observations about Epididymal Cysts Found in a Cohort of Michigan Men

Abstract Introduction Epididymal cysts (EC) are an incidental finding on scrotal ultrasounds (SUS), with an anecdotal prevalence from 5-20% with peaks at age 2 and in puberty. A recent survey at a children’s hospital in Michigan found that up to 35% of boys 15 or older had ECs. While adult men often demonstrate EC, comparatively few papers characterize the prevalence of ECs in adults. It is presumed that ECs most commonly develop during their 20s-40s but no clear prevalence by age has been established in the general adult population. Objective This present research will investigate within the same geographic region the prevalence of ECs in adult men. Methods A retrospective review was conducted for men 18-years-of-age and older who underwent a Michigan hospital-based SUS between 2010 – 2015. Patients without EC and EC patients were compared using two-sample t test, associations between age and presence of ECs were evaluated by chi-square test, and associations between age and TTV were evaluated by one-way ANOVA and Pearson’s correlation coefficient. Results 357 out of 801 men (44.6%) were found to have sonographic evidence of ECs. When separated into age groups, the prevalence of ECs significantly increased (p=0.041) with increasing age. In men with only ECs, their TTV did not significantly decrease with age (r = 0.06, p=0.684), unlike men without EC (r = 0.18, p=0.028). Conclusions This geographic cohort of men have the highest prevalence of ECs reported in the global literature. Two novel observations are that ECs frequency increases with age and TTV is preserved with age in men with ECs. TTV correlates significantly with FSH, LH, testosterone, and sperm health – further investigation should examine how preserved TTV may correlate with these values. Future studies should also examine the link between endocrine disrupting compound exposure and development of ECs. Disclosure No.

Evidence Based Classical Ayurveda Management the Epidydimal Cysts

Epididymal cysts are collection of fluid in a single sac (unilocular) or more than one (multilocular) as a result of dilatation of efferent epididymal tubules due to tubular obstruction with benign in nature and often bilateral in nature. It involves the development of fluid-filled sacs or cysts within the epididymis, a coiled tube located behind each testicle. An epididymal cyst, also known as a spermatocele that affects the male reproductive system. If it is not treated it may develop to an abscess and probably the destruction of the epididymis which can lead to infertility. In Ayurveda it can be under the heading Kaphaja Granthi. A 27-year-old male patient visited the outpatient department of Kayachikitsha with complaints of bilateral scrotal swelling with itching since six months. Patient was diagnosed on the basis of colour doppler of scrotum and it indicates bilateral epididymis head cyst with minimal fluid seen around left spermatic cord with herniation of omental fat on Valsalva. The patient was treated with classical management of Kapahaja Granthi described in texts, Vaman (medicated emesis), Virechana (therapeutic purgation) and followed by administered Arogyavardhini Vati 2 tablet each of 250mg twice a day in empty stomach, Kanchanara Guggulu two tablet each of 500mg twice a day after food with lukewarm water and Varunadi Kashaya 40ml once a day in morning empty stomach. After this treatment there was no scrotal swelling also the colour doppler study reveals normal colour doppler study with no significant abnormality noted. This case indicates the Ayurveda classical management given in texts can be helps to manage the condition like epidydimal cyst.

Von Hippel-Lindau is Associated to Pancreatic Neuroendocrine Tumors: A Comprehensive Review.

Multiorgan tumors are a hallmark of the autosomal dominant genetic disorder known as Von Hippel-Lindau syndrome (VHL), which is typically the result of inherited aberrations of the VHL tumor suppressor gene. The most frequent cancer is retinoblastoma, which can also occur in the brain and spinal cord, renal clear cell carcinoma (RCCC), paraganglioma, and neuroendocrine tumors. There may also be lymphangiomas, epididymal cysts, and pancreatic cysts or pancreatic neuroendocrine tumors (pNETs). The most frequent causes of death are metastasis from RCCC and neurological complications from retinoblastoma or central nervous system (CNS). Pancreatic cysts are present in 35-70% of VHL patients. Simple cysts, serous cysts, or pNETs are possible presentations, and the likelihood of malignant degeneration or metastasis is no greater than 8%. Although VHL has been associated with pNETs, their pathological characteristics are unknown. Furthermore, it is unknown whether variations in the VHL gene cause the development of pNETs. Hence, this retrospective study was undertaken with the main aim to examine whether pNETs are connected to VHL from a surgical perspective.

(287) Office-Based Epididymectomy and Spermatocelectomy Under Local Anesthesia – An Excellent Option to Avoid General Anesthesia and Increase Access to Timely Care

Abstract Introduction Epididymectomy is indicated for patients with focal epididymal pain and bothersome epididymal cysts or masses. Similarly, spermatocelectomy is indicated for spermatoceles that have becomes symptomatic due to size or pain. The majority of scrotal surgeries are performed in the operating room (OR) using general or monitored anesthesia. Here, we sought to evaluate our experience with office-based epididymectomy and spermatocelectomy using only local anesthesia. Objective To evaluate post-procedural complications and pain resolution following epididymectomy or spermatocelectomy, comparing procedures performed in the clinic with only local anesthesia, compared to the OR. Methods We identified patients who underwent epididymectomy or spermatocelectomy at our institution from 2018-2021. A chart review was performed to identify pertinent information including whether the procedure was performed in the OR under monitored/general anesthesia versus in the clinic using only local anesthesia. Post-procedural outcomes including pain resolution (if applicable) and 30-day complications were compared between those who underwent epididymectomy or spermatocelectomy in the OR versus the office. Statistical analysis was performed using the chi-squared test. Results A total of 112 patients were identified, including 23 (20.5%) who underwent epididymectomy and 89 (79.5%) who underwent spermatocelectomy. Mean patient follow-up was 14.8 months (SD 11.6). Indications for epididymectomy or spermatocelectomy included pain (n= 50, 44.6%), epididymal cyst/mass (n=6, 5.4%), and mass effect secondary to spermatocele (n=56, 50.0%). Fifty-seven procedures (50.9%) were performed in the office under local anesthesia. Nitrous oxide was used in 21 (36.8%) of these cases. Thirty-four patients (30.3%) were on anticoagulation/antiplatelet therapy prior to surgery including 22 (64.7%) who continued anticoagulation/antiplatelet therapy due to high-risk comorbidities. The adverse event rate within 30 days was similar between patients who underwent surgery in clinic versus OR (p=0.67). Specifically, adverse events occurred in 9 patients (8.0%), of whom 4 had their procedure performed in the clinic (7.0% of clinic procedures) and 5 had their procedure performed in the OR (9.1% of OR procedures). Specific adverse events included postoperative hematoma in 6 patients (66%) and a single case of each of the following: infection, inability to void postoperatively, and intestinal obstruction. Hematoma rates did not differ significantly between those who were or were not on anticoagulation perioperatively (p=0.057). In patients with reported adverse events, 3 (33.3%) required reoperation. Of the 50 patients who underwent epididymectomy or spermatocelectomy for scrotal content pain, 39 had sufficient documentation available to evaluate pain resolution. 82% (n=32) reported 50% improvement in pain. There was no statistically significant difference in the likelihood of reporting significant pain reduction based on the location of the procedure (OR versus clinic). Conclusions Epididymectomy and spermatocelectomy can be successfully carried out in the office using only local anesthesia, including in those patients who are high risk for general anesthesia or require maintenance of anticoagulation perioperatively. Pain improvement may be anticipated in the majority of appropriately selected patients following treatment in either the clinic or OR. Disclosure No

Presentation and management outcome of symptomatic epididymal cysts in children: A case series

IntroductionEpididymal cysts usually develop in adults with rare occurrence in children. There is a shortage concerning our knowledge about this rare pathology in children. We present our experience with the presentation and management outcome of symptomatic epididymal cysts in children. MethodsA retrospective analysis of 7 patients with symptomatic epididymal cysts during the period from October 2017 to June 2022 was conducted. Recorded data included age and mode of presentation, findings on physical examination and scrotal U/S, spontaneous resolution and its duration, indications of surgical intervention, and post management follow up. All patients underwent an initial plan of conservative management. Surgical intervention was indicated in patients with persisting symptoms and/or failure of lesion's resolution on periodic follow up of 3 months interval. ResultsThe average age of patients was 7.9 years. Scrotal pain was the leading presenting symptom in 4 (57.1%) patients. The diagnosis was confirmed in all patients by scrotal ultrasonography. Spontaneous resolution was reported in 5 (71.4%) patients with an average duration of 9 months. Surgical excision was indicated in 2 (28.6%) patients. Recurrence was not recorded in all patients who developed complete lesion's resolution, and patients were symptom free for 6 months of post management follow up. ConclusionThe majority of epididymal cysts in children can be managed conservatively. Resolution duration is directly proportional to the cyst size. Cysts larger than 10 mm less likely involute, and surgical excision may be indicated. Larger volume studies are needed to establish a more solid therapeutic regimen.

Microscopic Cyst Resection for the Treatment of Patients Diagnosed with Epididymal Cyst.

Epididymal cysts mostly occur in men aged 20-40 years old. Previous reports have covered concerns about postoperative complexes, including postoperative asoedema, hematoma, sustaining pain, and seminal tract obstruction in patients who have undertaken nonmicroscopic epididymal cyst resection or epididymal resection. Nonmicroscopic epididymal cyst surgery is suggested for patients with childbirth plans as a precaution. The treatment of male epididymal cysts via microtechnology is obviously a beneficial option; we took the lead in carrying out microscopic epididymal exploration and cyst resection surgery in China. From September 2017 to April 2021, 41 young and middle-aged male patients diagnosed with epididymal cysts underwent microtechnology treatment in a program titled "microscopic epididymal exploration and cystectomy". The postoperative follow-up lasted for 3-50 months. The results confirmed that, as microscopic manipulation largely improved visualization of the subtle tissue structures of the epididymis, the cyst could be clearly dissected apart and completely removed intact under the microscope. Bleeding during the operation was significantly reduced (2-3 mL) and wound drainage was not required. According to follow-up data, microscopic treatment significantly reduced the incidence of postoperative scrotal hematoma, edema, and long-term postoperative pain, thereby promising a higher surgical success rate as well as recurrence prevention. Besides, preliminary experience and reflection suggest that microscopic epididymal exploration and cystectomy provide efficient preservation of the epididymal patency through refined treatment, while a better prognosis can be achieved. We recommend that surgery be carried out before the epididymal cyst develops to 0.8 cm in diameter, for fear that a larger epididymal cyst (>0.9 cm in diameter) could cause the complete destruction of all tubules of the ipsilateral epididymis - a more severe case with damage to the testicular output network.

Evaluation of Scrotal Pathologies by Ultrasound and Color Doppler.

Introduction Due to its ease of use, lack of ionizing radiation exposure, noninvasive nature, reproducibility, low cost, and ease of accessibility, ultrasound (US) is the preferred imaging modality for evaluating scrotal disease. High-resolution US and color Doppler better highlight scrotal and testicular diseases because of the scrotum's superficial anatomy. The genital organs are subjected to damaging ionizing radiation during CT, while MRI is both costly and uncommon. Aims and objectives The aim of this study is to use ultrasonography (USG) to examine various scrotal diseases and to diagnose and identify different disorders utilizing high-resolution US and color Doppler. Materials and methods The study was done on 60 patients who were referred to theDepartment of Radiodiagnosis by the General Surgery and Urology departments for the scrotal US and Doppler study. This study was conducted between October 2021 and March 2022 at the Indira Gandhi Institute of Medical Sciences, Patna, India. Results Out of 60 patients, hydrocele was seen in 25 cases, scrotal hernia in 12 cases, undescended testis in eight cases, varicocele and epididymal cysts in seven cases, etc. In acutely painful scrotal disorders, high-frequency US with color Doppler sonography successfully distinguishes between testicular ischemia/torsion and acute inflammatory illnesses. Eighteen cases of inflammatory scrotal pathologies and one case of testicular torsion were seen. Conclusion In detecting and assessing scrotal diseases, high-frequency USG and color Doppler sonography have good sensitivity and specificity. Furthermore, the lack of ionizing radiation, simplicity, wide availability, cost-efficiency, and reproducibility make it a highly important method for scrotal diseases.