From the Research
The primary treatment for epididymal cysts is typically observation, as most are benign and do not require intervention, but surgical excision is recommended for patients with persistent scrotal pain or large cysts that do not regress after a follow-up of 24-48 months, as suggested by the most recent study 1. The treatment approach for epididymal cysts depends on the size of the cyst, the presence of symptoms, and the patient's overall health.
- For asymptomatic cysts with a diameter smaller than 1 cm, conservative treatment is recommended, as approximately 50% of epididymal cysts involute within an average of 17 months 1.
- For large asymptomatic cysts with a diameter greater than 1 cm that do not regress after a follow-up of 24-48 months, surgical excision is recommended 1.
- For cysts that cause persistent symptoms, surgical excision is also recommended, as it can provide immediate remission of symptoms, as seen in a study where 11 cases of symptomatic epididymal cysts were treated with surgical exploration and removal of the cyst, resulting in uncomplicated postoperative care and immediate remission of symptoms in all cases 1. Additionally, other treatment options such as pain management with over-the-counter pain relievers, aspiration, and sclerotherapy may be considered, but the most recent and highest quality study 1 suggests that surgical excision is the most effective treatment for persistent or large cysts. It is essential to note that the treatment approach should prioritize the patient's quality of life, morbidity, and mortality, and the decision to intervene should be based on the presence of symptoms and the size of the cyst, rather than the presence of the cyst itself. The use of ultrasound scanning for diagnosis and follow-up is also crucial in managing epididymal cysts, as it can help identify the size and location of the cyst and monitor its progression over time 1.