An 18-year-old male presents with sudden inguinal pain that did not result from an injury or lifting. A physical examination demonstrates no bulging at the inguinal canal. There is moderate tenderness, the testicle does not rise or fall with temperature change, and there is no erythema or swelling. The patient is not sexually active, his urine is negative, and there is no discharge or fever. A sonogram reveals a 9-mm epididymal cyst. The urologist is not concerned. How do you treat this patient?—Patricia Schroeder, FNP-C, Abilene, Texas

Epididymal cysts are an incidental finding in approximately 30% of asymptomatic males. I am wondering about the location of the epididymal cyst found on ultrasound. The location of the cyst gives a helpful clue in defining the cyst.

A spermatocele is a cyst that usually arises from the head of the epididymis. Its sac contains spermatozoa and is most often asymptomatic. A hydrocele usually arises from the anterolateral area of the testicle. Typically, it causes swelling of one or both testicles. A varicocele is a cluster of dilated veins arising from the spermatic cord. The patient often reports pain associated with physical exertion and relief upon rest.

From the information you have provided, it sounds like this may be a spermatocele. These cysts are typically self-limiting. NSAIDs are recommended for discomfort. However, if the patient’s discomfort persists, then perhaps he should return to the urologist for re-evaluation.

On occasion, surgical intervention such as spermatocelectomy or sclerotherapy is indicated.—Laura A. Foster, CRNP, FNP

References

  1. Crawford P, Crop JA. Evaluation of scrotal masses. Am Fam Physician. 2014;89:723-727.
  2. Weerakkody Y, et al. Epididymal cyst. Available at: https://radiopaedia.org/articles/epididymal-cyst (Accessed December 27, 2017).
  3. Pais VM, Kim ED. Spermatocele. Available at: https://emedicine.
  4. medscape.com/article/443432-overview (Accessed December 27, 2017). 


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