Epididymal cysts in childhood - conservative or surgical approach?

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.