Kista Epididimis presentasi penyakit.pptx

Ppt

1. Kista epididimis Dianita Halimah Harahap Supervisor: dr. Ponco Birowo , SpU (K), PhD

2. Introduction Simple cystic structures that may be palpable by the patient or examining physician or found incidentally by ultrasonography Arise form the cystic accumulations of semen in the epididymal tubules, rete testes, or efferent ductuli. Indistinguishable with spermatocele, except Post-pubertally contain sperm

3. Introduction

4. Introduction 14.4% of all boys who underwent scrotal ultrasound had epididymal cyst with increasing incidence with age (35.3% among boys >15 years) Incidence of epididymal cysts rises with age in children and this was attributed to the hormonal condition Epididymal cystic lesions appear in approximately 31% of 20- to 39-year-old men and up to 43% of asymptomatic 40- to 59-year-old men

5. Pathophysiology The pathophysiology of epididymal cysts is unknown but may be related to an altered hormonal environment because they are linked to diethylstilbestrol (DES) exposure Simple lesions are different ultrasonographically and pathologically from the multicystic , solid epididymal cystadenomas that occur in von Hippel- Lindau disease

6. Von Hippel- lindau disease Patients with VHL disease (and other hereditary RCC syndromes) should undergo screening for RCC and other syndrome-associated diseases. VHL should be considered in any patient with early onset or multifocal RCC or RCC in combination with any of the following: a history of visual or neurologic disorders; coexistent pancreatic cysts, epididymal lesions, inner ear tumors ; family history of blindness central nervous system tumor renal cancer

7. Clinical symptoms Scrotal discomfort Pain in scrotal area Palpable mass.

8. Radiology exam ULTRASONOGRAPHY cyst contents in uncomplicated cases are anechoic with no internal echoes posterior acoustic enhancement may be seen well-defined anechoic lesions larger cysts may contain septations larger cysts may displace the testis this is a differentiating point from hydrocele which envelops the testis

9. Management Spontaneous resolution in many cysts, and surgical intervention is rarely needed Conservative management  due to its benign nature and spontaneous regression of these lesions Epididymal cysts below 3 cm are reported to regress spontaneously. Spermatoceles and epididymal cysts should only be surgically treated if there is discomfort, infection, disability caused by size, or infertility Diameter more than 3 cm in  surgical intervention Men of reproductive age should be counselled on the risk for obstructive azoospermia associated with epididymal cyst surgery, particularly if the epididymal cyst is located in the corpora or cauda of the epididymis

10. Surgical management The most common approach: trans-scrotal incision and dissection to the level of the tunica vaginalis. The tunica vaginalis is sharply opened and the epididymal cyst or spermatocele is exposed. Dissect the cyst or spermatocele down to its stalk and to ligate it with a 5-0 or 6-0 absorbable suture If the epididymal cyst or spermatocele cannot be completely dissected off the testis, a portion of the cyst wall can be unroofed and the tunic of the epididymis should be reapproximated with a 4-0 absorbable suture to cover the defect. Haemostasis is obtained with bipolar cautery.

11. Excision of epididymal cysts Surgery is approached with the same incision as for a hydrocele procedure. Spermatocelectomy should be done without opening the cyst. Sharp dissection is recommended, the cyst structure may be excised from the epididymis without excessive mobilization of the epididymis and testis. If attachments to the epididymis are present they can be dissected and ligated. Haemostasis should be accomplished by cautery. The edges of the epididymis are re-approximated, or a portion of fascia or tunica may be used to close the defect. It may be necessary to perform hydrocelectomy in conjunction with this procedure

12. EPIDIDYMECTOMY

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