From the Research
For an enlarging simple epididymal cyst measuring 2.5 cm in a middle-aged male, surgical excision is recommended due to the size of the cyst, as it is larger than the recommended threshold for surgery. According to the study by 1, surgery is indicated when the epididymal cyst is larger than 0.8 cm in diameter to prevent complete destruction of the epididymis. In this case, the cyst is 2.5 cm, which is significantly larger than the recommended threshold.
The patient should undergo ultrasound evaluation to confirm the diagnosis and rule out other scrotal pathologies before considering surgery. Pain management with over-the-counter analgesics like acetaminophen or ibuprofen can help with discomfort. Aspiration of the cyst fluid is generally not recommended as a primary treatment due to high recurrence rates. The patient should be advised to seek prompt medical attention if he experiences sudden severe pain, rapid enlargement, or signs of infection such as redness, warmth, or fever.
Some key points to consider in the management of epididymal cysts include:
- The benign nature of these cysts, as malignant transformation is extremely rare 2, 3
- The importance of monitoring the size of the cyst with regular follow-up ultrasounds every 6-12 months 4
- The potential benefits of surgical excision, including relief of symptoms and prevention of further complications 5
- The use of microscopic epididymal exploration and cystectomy as a safe and effective treatment option, which can reduce the incidence of postoperative scrotal hematoma, edema, and long-term postoperative pain 1