From the Guidelines
Epididymal head cysts are typically benign and require no treatment if they are small, painless, and not causing any symptoms, but medical intervention may be necessary if the cyst becomes large, painful, or causes discomfort. The management of epididymal head cysts depends on their size, symptoms, and impact on the patient's quality of life. According to the most recent study 1, the acute scrotum is a medical emergency that requires rapid and accurate diagnosis to triage potentially surgical and irreversible conditions from patients for whom conservative management is sufficient.
Diagnosis and Treatment
- Epididymal head cysts can be diagnosed using ultrasound, which can help differentiate them from other scrotal masses 1.
- Treatment options for epididymal head cysts include aspiration (draining the fluid with a needle) for temporary relief, though recurrence is common, or surgical removal (epididymal cystectomy) for permanent resolution 1.
- Surgery is typically performed as an outpatient procedure under local or general anesthesia.
- During recovery, patients should rest for 1-2 days, avoid strenuous activities for 1-2 weeks, and may need mild pain relievers like acetaminophen or ibuprofen.
Prevention and Screening
- Regular self-examination of the testicles can help detect any changes early, and any new or growing scrotal mass should be evaluated by a healthcare provider to rule out more serious conditions 1.
- Epididymal head cysts form when sperm-carrying tubules become obstructed or when there's abnormal development of the epididymis, leading to fluid accumulation.
- Early detection and treatment can help prevent complications and improve patient outcomes, reducing morbidity, mortality, and improving quality of life 1.
From the Research
Epididymal Head Cyst Overview
- Epididymal cysts are benign masses that are more common than previously thought in prepubertal age 2
- They can be easily characterized and differentiated from spermatocele using ultrasound imaging 2
- Conservative management constitutes the treatment of choice in the majority of cases, and surgery is recommended only in selected cases 2, 3
Diagnosis and Symptoms
- Epididymal cysts are usually asymptomatic, but can cause scrotal mass and pain in some cases 2, 3
- The diagnosis of epididymal cysts is made by physical examination and confirmed by ultrasound (US) 3
- Most epididymal cysts are incidental, and there is no difference between pre- and post-pubertal cohorts in terms of presence of hydrocoeles, symptoms, or rate of resolution 4
Treatment Options
- Microsurgical epididymal cystectomy is a safe and effective treatment for epididymal cystic lesions in young men with fertility requirements 5
- This surgery does not impact upon sperm count, motility, morphology, or epididymal function 5
- Minimal epididymal cystectomy with scrotoscope (MECS) is a new surgical technique that provides a clear vision of scrotal contents and has been shown to be safe and effective 6
- Conservative management is practical, but surgical excision is recommended in patients with intractable scrotal pain or if the cyst size does not seem to involute 3
Management and Follow-up
- Epididymal cysts can be safely managed non-operatively without the use of continued US surveillance or urological referral 4
- These children should not require continued follow-up with repeat surveillance imaging solely for epididymal cysts and could be managed in the primary care setting as part of routine clinical examination 4
- Follow-up is necessary to investigate sperm count, motility, morphology, and improvement of symptoms, recurrence, and complications after surgery 5