An Overview of an Epididymal Cyst

An epididymal cyst is a fluid-filled pocket that forms in the epididymis, a coiled tube in the back of the testicle that stores and transports sperm. These cysts are benign (not cancerous), typically painless, and can be very common with age. They do not affect fertility.

Often, there are no signs an epididymal cyst is forming. But once one has, you may notice a small, water balloon-like mass and experience tenderness and swelling of the testicle, as well as other symptoms.

Epididymal cysts usually don't require treatment, but it's important to have any growths examined by a healthcare provider just in case something more serious may be at play, such as a tumor or hernia.

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

Epididymal Cyst Symptoms

There are usually no symptoms that warn that an epididymal cyst is forming. Once one is present, you may notice a ball behind, above, or below one of your testicles, as well as:

• 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 testicular cysts to form, but it's possible that inflammation or a blockage of the epididymis may set the stage for them to develop.

Note, however, that epididymal cysts are not the same as epididymitis. This is painful inflammation of the epididymis tubes caused by a bacterial or viral infection.

Diagnosis of Epididymal Cysts

Testicular 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 testicular 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.

You 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.

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. Healthcare providers 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 you can't have surgery or do 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 healthcare providers 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.

You 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, you 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.

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.