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

Summary

Here, we present a protocol to treat patients diagnosed with an epididymal cyst using microscopic cyst resection. Based on microscopic manipulation, a largely improved visualization of the subtle tissue structures of the epididymis was obtained, so the cyst could be clearly dissected apart and completely removed intact.

Abstract

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.

Introduction

Epididymal cysts mostly occur in men aged 20-40 years old, although some literature also exists concerning epididymal cysts in childhood^1,2. Previous reports have covered concerns about surgical destruction and postoperative scarring in patients undertaking nonmicroscopic epididymal cyst resection or epididymal resection^3,4. Other postoperative complexes include seminal tract obstruction, immune infertility, and testicular atrophy. There is also a higher risk for postoperative occurrence, and even recurrence, of hematoma, edema, and a sustaining pain a....

Protocol

We performed retrospective analysis of the clinical data of male patients, initially diagnosed with epididymal cysts, admitted to the urology inpatient department of the Affiliated Hospital of Kunming University of Technology (the First People's Hospital of Yunnan Province). Written, informed consent must be obtained from patients before surgery.

1. Clinical inclusion and exclusion criteria

1. Include patients who are below 45 years of age and have a need to preserve fertility.
   ​NOTE: The patient in this study was younger than 45 years old.
2. Include patients with a clinician's prelimin....

Results

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."

Here, we show the data from a single patient as a representative example. The patient was operated on for descending surgery (testicular and epididymal exploration and microscopic cyst removal) under general anesthesia. A scrotal incision was made, the testicular sheath was cut, the.......

Discussion

As we mentioned previously, epididymal cysts mostly occur in men aged 20 to 40 years, while there is also some literature on epididymal cysts in childhood^1,2. To date, the cause of epididymal cysts is not clear, and there is no specific medicine for its treatment. In addition to a few reports that epididymal cysts can resolve spontaneously without surgery⁷, most epididymal cysts, although their progression and enlargement are relatively sl.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Ablation electrode	Baisheng Medical Devices Co., Ltd. China	OBS-Db
Anesthesia apparatus	Datex-Ohmeda,Inc.USA	Aespire View, Datex-Ohmeda
Compact Anesthesia Monitor	GE Healthcare Finland OY.Finland	S/5 Compact
Electric knife	Valleylab.USA	Valleylab Force FX-8C
Surgical (operation) microscope	Lecia Microsysterms (Schweiz) AG. Germany	Lecia M525 F20