An epididymal cyst is a fluid-filled sac that develops in the epididymis. These cysts are generally benign and painless, though larger cysts can cause discomfort or swelling in the scrotum. Diagnosis is often made through a physical examination and confirmed with an ultrasound. Symptoms may include a painless lump, a sensation of heaviness, or mild scrotal discomfort. Treatment is typically unnecessary unless the cyst causes significant symptoms.

What is “epididymal cyst”?

An epididymal cyst is a small, fluid-filled sac that develops in the epididymis, which is a tube situated at the back of the testicle that helps in the storage and transport of sperm. These cysts are usually harmless and filled with a clear or milky fluid that may contain sperm. Most epididymal cysts are painless and are discovered incidentally, but if they become large, they might cause a feeling of heaviness, mild discomfort, or swelling in the scrotum. They are non-cancerous and rarely require treatment unless they cause discomfort, in which case surgical removal may be considered.

Causes of epididymal cyst

The exact cause of an epididymal cyst is not always clear, but some potential factors include:

• Blocked Tubules: Small tubes within the epididymis may become blocked, leading to the formation of a fluid-filled sac or cyst.
• Developmental Factors: Some cysts are thought to develop naturally as a person ages, particularly during periods of hormonal changes, like puberty or middle age.
• Injury or Trauma: Physical injury to the scrotum or testicles may sometimes result in the formation of a cyst in the epididymis.
• Inflammation or Infection: Inflammation (epididymitis) or infection in the epididymis can contribute to cyst formation.
• Spermatocele: Sometimes, epididymal cysts can be filled with sperm. These are specifically called spermatoceles and are often associated with similar causes, like blocked ducts or past infections.

Symptoms of epididymal cyst

The symptoms of an epididymal cyst can vary, but common signs include:

• Painless lump: A smooth, painless lump or swelling in the scrotum, typically felt at the top or back of the testicle.
• Swelling in the scrotum: A noticeable swelling or enlargement in one side of the scrotum.
• Heaviness or fullness: A sensation of heaviness or fullness in the scrotum, especially if the cyst grows larger.
• Discomfort or mild pain: Some individuals might experience mild discomfort or aching in the scrotum, particularly if the cyst presses on surrounding tissues.
• Noticeable cyst: In some cases, the cyst can be visible if it’s large enough, appearing as a small, fluid-filled sac under the skin.

Diagnosis of epididymal cyst

The diagnosis of an epididymal cyst typically involves several steps, including:

• Physical examination: A doctor will manually examine the scrotum and testicles to feel for lumps, swelling, or abnormalities. An epididymal cyst is often detected as a smooth, firm, and mobile mass at the top or back of the testicle.
• Transillumination: The doctor may shine a light through the scrotum to see if the lump is fluid-filled. A cyst will usually allow light to pass through, indicating that it contains fluid, unlike a solid mass.
• Ultrasound: If the diagnosis is unclear, an ultrasound scan of the scrotum is the most common and effective imaging test. It uses sound waves to create a picture of the structures inside the scrotum, helping to confirm if the lump is a fluid-filled cyst rather than a solid mass.
• Medical history and symptoms review: The doctor may also ask about any symptoms, history of trauma, infections, or other conditions that might have contributed to the development of the cyst.

Treatment of epididymal cyst

Treatment for an epididymal cyst depends on the size of the cyst and the severity of symptoms. Common treatment options include:

• Observation: If the cyst is small, painless, and not causing discomfort, no treatment is usually necessary. Many epididymal cysts are monitored over time to ensure they do not grow or cause symptoms.
• Pain Relief: Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage mild discomfort or pain associated with the cyst.
• Aspiration: In some cases, the fluid inside the cyst can be drained using a needle (aspiration). However, this is not a permanent solution, as the cyst may refill with fluid over time.
• Sclerotherapy: After aspiration, a special chemical can be injected into the cyst to scar the lining and prevent it from refilling. This is generally used for cysts that are recurrent or bothersome, but it’s not commonly done due to potential complications.
• Surgical removal (excision): If the cyst is large, painful, or causing significant discomfort, a minor surgery called epididymectomy may be performed to remove the cyst. This is a more permanent solution and is typically done on an outpatient basis under local or general anesthesia.

Indications of surgery for an epididymal cyst

Most epididymal cysts are harmless and do not require intervention. Surgery for an epididymal cyst is usually considered only if specific indications are present. These include:

• Persistent pain or discomfort: When the cyst causes ongoing discomfort or pain that does not respond to conservative treatments like pain relievers.
• Large Size: If the cyst grows large enough to cause noticeable swelling, discomfort, or a feeling of heaviness in the scrotum, surgery might be recommended.
• Impact on quality of life: If the cyst interferes with daily activities, physical exercise, or sexual function, surgical removal may be indicated.
• Recurrent infections: In rare cases, if the cyst becomes repeatedly infected or inflamed, surgery might be necessary to prevent further complications.
• Concerns about malignancy: If there is any doubt about the nature of the cyst (although epididymal cysts are generally benign), surgical removal may be recommended to rule out other conditions.

Summary

An epididymal cyst is a fluid-filled sac that forms in the epididymis, a small tube at the back of the testicle responsible for storing and transporting sperm. These cysts are usually benign, painless, and filled with clear or milky fluid. While most do not cause symptoms, larger cysts can lead to swelling, discomfort, or a sensation of heaviness in the scrotum. Diagnosis is typically made through a physical examination and ultrasound. Treatment is often unnecessary unless the cyst causes significant discomfort, in which case surgical removal may be considered.

Prof. Dr. Emin ÖZBEK

Urologist

Istanbul- TURKIYE