1. Cysts connected with the epididymis

2. Types
Cysts of the epididymis
Spermatocele

3. Cysts of the epididymis
Congenital, derived from an embryonic remnant around the epididymis
Filled with crystal clear fluid

4. Cysts of the epididymis: clinical features
Found during middle life
Usually bilateral
Cysts:
Located behind the body of the testis
Tense (aggregation of a number of small cysts like bunch of tiny grapes)
Fluctuation difficult appreciate
Transillumination: Chinese lantern pattern

5. Cysts of the epididymis: D/D
Cysts of the appendages of the testis

6. Cysts of the epididymis: T/t
If small no T/t is needed
Surgical if the cyst is large & causing discomfort
Aspiration is useless, as these cysts are usually multilocular

7. Spermatocele Acquired Unilocular Retention cyst
Cysts contain fluid resembling barley – water containing spermatozoa

8. Spermatocele: clinical features
Scrotal swelling
Location: head of the epididymis, above & behind the body of testis
Testis can be felt separately from the body of the testis
Soft
Fluctuation: usually positive
Transillumination test: negative

10. Testicle (grey) and Spermatocele (black)

11. Spermatocele: T/t
Aspiration
Excision of the cyst