An Overview of an Epididymal Cyst

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 lump in the testicle and can be very common with increasing age.

Epididymal cysts are sometimes referred to as spermatoceles, but this a different kind of cyst that holds fluid including sperm within the cyst; an epididymal cyst holds fluid only.

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

Epididymal Cyst Symptoms

Epididymal cysts typically have no symptoms prior to forming in the epididymis. Once formed, you may notice a pea-sized (or larger) ball behind, above, or below one of your testicles where sperm is produced. For spermatoceles, the cyst is typically found on the top of the testicles.

Other symptoms of an epididymal cyst may include:

• Dull pain in the scrotum (the pouch that holds the testicles)
• A feeling of heaviness in the scrotum
• Redness in the scrotum area
• Increased pressure at the bottom of the penis
• Tender or swollen epididymis
• Tender, swollen, or hardened testicles
• Pain in the groin or lower back and abdomen

Epididymal cysts typically don’t have symptoms of sharp, intense pain and are commonly completely painless. If any of the above symptoms occur, a full immediate workup by a urologist is warranted.

Causes

The cause of an epididymal cyst is unknown. In the case of a cyst that’s diagnosed as a spermatocele, it may be caused by an obstruction in the epididymis that results in a backup of fluid and sperm.

Diagnosis

Epididymal cysts are typically found during a self-exam of the testicles or during a physical exam with a physician. Aside from an exam, to diagnose an epididymal cyst your doctor may shine a light behind each testicle to test the transparency of each one and determine if there are any masses blocking the light from shining through.

This will confirm if the lump is an epididymal cyst or spermatoceles as the light will be able to get through to the other side. Dense masses, like a tumor, will block the light from shining through.

Your doctor may also order a scrotal ultrasound, which is a fast and accurate way to determine testis and epididymal anatomy and blood flow and whether the mass is a cyst or something more serious.

After determining the mass type your general practitioner will likely refer you to a urologist to monitor the epididymal cyst’s growth and any symptoms that may be associated with it.

There’s no way to tell what kind of cyst is in the testicle with just a physical exam or ultrasound, which is why the terms epididymal cyst and spermatoceles are used interchangeably.

Treatment

Most epididymal cysts are only treated if they have symptoms that are causing pain or discomfort. Otherwise, once diagnosed, they are monitored by regular self-exams and physician follow-up.

In general, epididymal cysts and spermatoceles will either get smaller in size as the body reabsorbs fluid from the cyst or they will stay the same size. In some cases, an epididymal cyst may continue to get larger in size 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 anesthetic to fall asleep for the duration of the procedure, or you’ll be given a spinal anesthetic which will leave you awake but completely numb from the waist down.

Surgeons will then make an incision in the scrotum, separating the cyst from the epididymis and testicle while preserving the blood supply to the epididymis. The layers of the scrotum are then closed with dissolvable stitches. Antibiotics may be given before the procedure starts to protect against infection.

Patients may experience 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 as opposed to 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 and make the best choice based on your age and any life decisions you may be considering.

Aspiration

This method of removal drains the epididymal cyst by inserting a needle into the testicle, directly into the cyst, to eliminate the fluid buildup. This is not often recommended by physicians as there’s a good chance the fluid will re-accumulate quickly again.

Percutaneous Sclerotherapy 

In some cases, when an epididymal cyst keeps growing back after aspiration, surgery is generally considered. However, a less-invasive procedure called percutaneous sclerotherapy can be performed if a patient is not a surgical candidate or does not desire surgery.

This is an outpatient procedure that uses an ultrasound to help place a catheter into the cyst to deliver a contrast dye into the cyst. This lets physicians see the cyst more clearly as well as monitor any leaking or complications the cyst may be having on other organs.

Once approved, a fluid (usually ethanol which helps in killing cells in the cyst) is inserted through the catheter into the cyst wall for a length of time, 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 and the patient is monitored during follow-up visits a few months after the procedure.

In cases where the epididymal cyst is not smaller or eliminated a second sclerotherapy procedure may be recommended.

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 be proactive and check your testicles monthly, so you’re aware of any cysts or masses you may have as well as its size and density.

All masses need to be checked out by a doctor, regardless of if you think it’s an epididymal cyst or not, to rule out a more serious condition.