Treatment of Testicular Cysts
Testicular cysts should be managed conservatively with observation and regular follow-up ultrasound unless they are symptomatic or have concerning features, in which case testis-sparing surgery is recommended. 1, 2
Diagnosis
- High-frequency (>10 MHz) scrotal ultrasound with Doppler is the gold standard for diagnosis of testicular cysts 1, 2
- Ultrasound characteristics of simple testicular cysts include:
- Anechoic mass within the testicular parenchyma
- Well-defined walls
- Enhanced posterior through transmission
- No internal vascularity on Doppler examination 3
- Serum tumor markers (AFP, β-hCG, LDH) should be measured to rule out testicular malignancy 1, 2
Management Approach
For Asymptomatic Simple Cysts
- Conservative management with observation is appropriate 3
- Patient education on testicular self-examination is recommended 2
- No further evaluation or follow-up is required for isolated testicular cysts without other abnormalities 2
For Symptomatic Cysts or Cysts with Concerning Features
- Testis-sparing surgery (cyst unroofing or enucleation) is the treatment of choice 4, 5
- Indications for surgical intervention include:
- Pain or discomfort
- Large size (>6 cm)
- Progressive enlargement on serial ultrasounds
- Complex features raising concern for malignancy 6
Special Considerations
- In patients with a single testicle, testis-sparing surgery should be prioritized to preserve fertility and hormonal function 1
- Sperm banking should be discussed before surgical intervention, especially if significant testicular volume might be affected 2
Follow-up
- For cysts managed conservatively, follow-up ultrasound at 6-8 weeks is recommended to ensure stability 1
- Any changes in size, echogenicity, or vascularity warrant reassessment of management approach
Important Caveats
- Testicular microlithiasis without other risk factors does not confer increased risk of malignancy and does not require further evaluation 1, 2
- Simple testicular cysts must be differentiated from cystic testicular tumors, which require more aggressive management 1
- Scrotal violation must be strictly avoided during any surgical intervention as it increases risk of local recurrence if the lesion is malignant 2
The prevalence of testicular cysts may be higher than previously thought, with one study finding them in nearly 10% of men undergoing high-resolution ultrasonography 7. While most testicular cysts are benign and can be managed conservatively, careful evaluation is essential to distinguish them from malignant lesions.