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Epididymal cysts in childhood - conservative or surgical approach?
Jerzy Niedzielski1, Mieczysław Miodek, Marek Krakós
1Department of Pediatric Surgery and Urology, Chair of Pediatric Surgery, University School of Medicine in Łódź, University Children's Hospital, No 4 in Łódź.
Insights
Epididymal cysts (ECs) are more common in boys over 14. Conservative management is recommended for smaller cysts, with surgery reserved for larger or growing cysts.
Area of Science:
- Pediatric Urology
- Adolescent Medicine
- Diagnostic Imaging
Background:
- Epididymal cysts (ECs) are common findings in pediatric scrotal examinations.
- Understanding their prevalence and management is crucial for appropriate clinical decision-making.
Purpose of the Study:
- To determine optimal treatment strategies for pubertal epididymal cysts in boys.
- To establish clear criteria for surgical intervention versus conservative management.
Main Methods:
- Retrospective review of scrotal ultrasound results from 363 boys and adolescents (2 months to 18 years).
- Analysis of cyst incidence, patient demographics, presenting symptoms, and treatment outcomes.
Main Results:
- Epididymal cysts (ECs) were found in 16.2% of patients, with higher incidence in boys over 14 years (33.8%).
- Half of ECs were incidental findings, while the other half presented as scrotal masses or pain.
- Conservative treatment led to resolution or stabilization in most cases; 52.5% underwent elective surgery.
Conclusions:
- Epididymal cysts (ECs) are more prevalent in older adolescent boys.
- Conservative management with ultrasound monitoring is advised for ECs <10 mm.
- Surgery is indicated for cysts >10 mm that increase in size or fail to involute.
The Aim Of The Study:
To decide on the accurate way of treatment and to establish criteria for operation in boys with pubertal epididymal cysts (ECs).
Material And Methods:
Results of scrotal ultrasound of 363 boys and adolescents, aged 2 months to 18 years, were reviewed retrospectively.
Results:
Of all 363 patients with scrotal ultrasound 59 (16.2%) at mean age of 14.03 yrs had ECs. The EC incidence increased with age and 42 out of 124 boys (33.8%) older than 14 yrs had cysts (chi2=27.627, p=0.000). Out of 59 patients, in 30 (50.8%) cysts were diagnosed incidentally at the time of scrotal US, 29 boys (49.2%) presented with scrotal mass and/or pain. 31 patients with ECs (52.5%) underwent elective surgery and the remaining 28 boys (47.5%) received conservative treatment. The age of boys with ECs who underwent surgery ranged from 8 to 18 years (mean 14.32). The age range of patients treated conservatively was 7-18 (mean 13.71). There was no statistical difference in age between boys treated surgically and conservatively (t=0.924, p=0.36). ECs resolved in 17 patients out of 28 boys treated conservatively, in remaining 11 boys the size of cysts was stabile and they remain asymptomatic. Clinical and ultrasonographic follow-up were carried out from 11 months to 5 years.
Conclusions:
ECs are more common in older boys (over 14 years). Management of ECs smaller than 10 mm should be conservative with clinical and ultrasound controls, leaving surgery for cysts increasing in size over 10 mm which did not involute with time.
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