Management of Simple Renal Cyst and Left Testicular Atrophy
Observation is the recommended management for both the patient's 3.2 cm simple renal cyst and left testicular atrophy, as both conditions are benign and asymptomatic.
Simple Renal Cyst Management
Diagnosis and Classification
- The patient has a right renal midpole simple cyst measuring 3.2 cm identified on CT A/P with contrast
- Simple renal cysts are common benign lesions that arise from the renal parenchyma 1
- The cyst appears to be a Bosniak I (simple) cyst with:
- No septations
- No solid components
- No enhancement
Recommended Management
- Observation is appropriate for asymptomatic simple renal cysts 1
- No follow-up imaging is indicated for asymptomatic simple renal cysts, even when they enlarge over time 1
- Natural history studies show that:
- 86% of simple renal cysts increase in size over time
- This growth is not associated with development of complex features or malignant transformation 1
When Intervention Would Be Indicated
- Intervention would only be necessary if the cyst becomes symptomatic (causing pain, obstruction, or hypertension)
- Options for symptomatic cysts include:
- Percutaneous aspiration with sclerotherapy (not simple aspiration alone, which has high recurrence rates) 2
- Surgical excision for persistent symptomatic cysts
Left Testicular Atrophy Management
Diagnosis
- Patient has left testicular atrophy with bilateral descended testicles
- No symptoms reported
- Incidental finding noted on imaging
Recommended Management
- Observation is appropriate for asymptomatic testicular atrophy 3
- Regular testicular self-examination should be recommended to monitor for any changes 3
- No immediate intervention is required in the absence of symptoms or suspicious features
Risk Assessment
- Testicular atrophy is associated with a slightly increased risk of testicular cancer, particularly when accompanied by:
- History of cryptorchidism
- Family history of testicular cancer
- Age <40 years 3
- The patient should be counseled about this slightly increased risk
Follow-up Recommendations
- Annual physical examination
- Prompt evaluation for any new scrotal symptoms or changes
- Consider scrotal ultrasound if any concerning changes are detected on physical examination
Monitoring Recommendations
Simple Renal Cyst
- No routine follow-up imaging is necessary for asymptomatic simple renal cysts 1
- Patient should report any flank pain, hematuria, or hypertension
Testicular Atrophy
- Annual physical examination
- Patient education on monthly testicular self-examination 3
- Ultrasound evaluation if any concerning changes are detected
Important Considerations
- The empty right hemiscrotum noted on imaging appears to be an imaging artifact since physical examination confirmed bilateral descended testicles
- The patient should be reassured that both conditions are benign and common
- The management approach prioritizes quality of life by avoiding unnecessary interventions while maintaining appropriate surveillance