An Overview of an Epididymal Cyst

A testicle lump that often goes away on its own

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An epididymal cyst is a fluid-filled cyst found in the epididymis, a coiled tube in the back of the testicle that stores and transports sperm. This creates a benign (not cancerous) lump in the testicle and can be very common as you get older.

Epididymal cysts are sometimes referred to as spermatoceles. But those are a different kind of cyst in which the fluid inside the cyst contains sperm. An epididymal cyst only holds fluid.

An epididymal cyst is also different from epididymitis, which is painful inflammation of the epididymis tubes caused by a bacterial or viral infection.

This article will discuss epididymal cysts, including what causes them, their symptoms, and how they're treated.

Epididymal Cyst Symptoms

Epididymal cysts usually have no symptoms before forming inside the epididymis. If one is present, you may notice a pea-sized (or larger) ball behind, above, or below one of your testicles. For spermatoceles, the cyst is often found on the top of the testicles.

Other symptoms of an epididymal cyst may include:

  • Dull pain in the scrotum (the sack that holds the testicles)
  • A feeling of heaviness in the scrotum
  • Redness in the scrotum
  • Feeling of pressure at the bottom of the penis
  • Tenderness or swelling at the back of the testicle
  • Tenderness, swelling, or hardening of the testicle itself
  • Pain in the groin or lower back and abdomen

Epididymal cysts usually don’t cause sharp, intense pain. Most of the time, they are completely painless. If any of the above symptoms occur, you should go see a urologist for a complete checkup.

Causes of Epididymal Cysts

Experts don't know what causes epididymal cysts to form. In the case of a spermatocele, it may be caused by a blockage in the epididymis. This causes a backup of fluid and sperm.

Epididymal cysts are common and harmless. However, if you do discover a lump in your testicles, it’s very important to make an appointment with your healthcare provider right away. They can check for a more serious cause of the lump, such as a tumor or hernia.

Diagnosis of Epididymal Cysts

Epididymal cysts are typically found during a self-exam of the testicles or during an exam at your healthcare provider's office. To determine the cause, the healthcare provider will do a physical exam, which may include shining a light behind each testicle.

Using a light will help the healthcare provider determine if there are any masses such as a tumor blocking the light from shining through. When the lump is an epididymal cyst or spermatocele, the light will be able to get through to the other side.

Your healthcare provider may also order a scrotal ultrasound. This test uses sound waves to look inside the scrotum. It can check the blood flow and show whether the mass is a cyst or something more serious.

It's not possible to tell whether cyst is an epididymal cyst or spermatocele with just a physical exam or ultrasound, however. That's why healthcare providers often refer to them by both terms.

After determining the cause of the lump, your healthcare provider will probably send you to a urologist to track its growth over time and manage any symptoms that may be associated with it.

Treatment of Epididymal Cysts

Most epididymal cysts are treated only if they cause pain or discomfort. Once diagnosed, you can do regular self-exams and follow up with your healthcare provider to monitor the cysts.

Usually, epididymal cysts and spermatoceles will either get smaller as the body reabsorbs fluid from the cyst or they will stay the same size. Sometimes, though, an epididymal cyst may continue to grow larger or cause pain, swelling, or embarrassment to the patient.

In these instances, there are a few options for treatment.

Surgery

Surgery is the most common treatment if you and your urologist decide your epididymal cyst needs to be removed. You will be put under general anesthesia to fall asleep for the duration of the procedure. But sometimes a healthcare provider may decide to give you a spinal anesthetic. This will leave you awake but completely numb from the waist down.

Surgeons will then make an incision in the scrotum. Next, they will remove the cyst from the epididymis and testicle while keeping the blood supply to the epididymis. They then sew up the scrotum with dissolvable stitches. The healthcare provider may prescribe antibiotics before the procedure starts to protect against infection.

Patients may have swelling and bruising for a few days after the procedure. There is a chance the epididymal cyst will grow back. But there’s less of a risk of this happening with surgery than with some of the other treatments for epididymal cysts.

In some cases, removing an epididymal cyst or spermatocele can affect male fertility. It may cause a blockage in the epididymis or damage the vas deferens, which carries sperm from the testicle to the urethra in the penis. This prevents the sperm from traveling out.

It’s important to discuss all of the possible side effects with your urologist before the procedure so you’re aware of your own personal risk. Then you can make the best choice based on your age and any life decisions you may be considering.

Aspiration

This method of removal involves inserting a needle into the cyst to drain it. This eliminates the fluid buildup. Physicians don't often recommend this method since there’s a good chance the fluid will quickly return.

Percutaneous Sclerotherapy 

In some cases, when an epididymal cyst keeps growing back after aspiration, the healthcare provider may recommend surgery. A less-invasive procedure called percutaneous sclerotherapy is another option if a patient can't have surgery or does not want to.

This is an outpatient procedure. The surgeon uses ultrasound to help insert a catheter (tube) into the cyst. Contrast dye is injected through the catheter into the cyst. This lets physicians see the cyst more clearly. It also helps them see if the cyst is leaking or affecting other parts of the testicle.

A fluid (usually ethanol, which helps in killing cells in the cyst) is injected through the catheter into the cyst for around 20 minutes.

The patient may be moved to different positions to make sure the fluid hits the entire cyst. The fluid is then aspirated out of the cyst.

After the procedure, the patient will usually have follow-up visits a few months later. If the epididymal cyst does not get smaller or go away, the healthcare provider may recommend a second sclerotherapy procedure.

Recap

Sometimes your healthcare provider may recommend percutaneous sclerotherapy instead of surgery. This is a less-invasive procedure where a catheter is used to inject contrast dye into the cyst. The surgeon aspirates the fluid from the cyst. If the cyst doesn't get smaller or go away, the healthcare provider may suggest another sclerotherapy procedure.

Summary

An epididymal cyst is a fluid-filled lump in the testicle that isn't cancerous. They develop in the coiled tube in the back part of the testicle and are common when you grow older. Most epididymal cysts go away on their own. However, you should see your healthcare provider to make sure a cyst isn't cancer.

The healthcare provider treats the cysts only if they cause pain, discomfort, or embarrassment. Common treatments include surgery, aspiration, or percutaneous sclerotherapy.

A Word From Verywell

It can be worrying to find a lump on your testicle, but epididymal cysts are common and nothing to worry about. It’s important to check your testicles monthly to look for any lumps. That way, you'll be aware of any cysts or masses you may have as well as how their size changes over time.

All masses need to be checked out by a healthcare provider, even if you think it’s an epididymal cyst. Doing this will rule out a more serious condition. 

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Article Sources
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  4. The Hospital of Central Connecticut. Spermatocele (epididymal cyst).

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