From the Research
For symptomatic epididymal cysts, surgical excision is recommended, particularly for cysts larger than 1 cm in diameter or those causing persistent symptoms, as it provides a definitive treatment with minimal recurrence rates, as supported by the most recent study 1.
Treatment Options
The treatment of epididymal cysts depends on the severity of symptoms and the size of the cyst.
- Asymptomatic or mildly symptomatic cysts can be managed conservatively with observation, as many cysts remain stable or resolve spontaneously.
- Over-the-counter pain medications like acetaminophen or ibuprofen (400-600mg every 6-8 hours as needed) can help manage discomfort.
- Supportive measures such as scrotal support, ice packs for 15-20 minutes several times daily, and avoiding strenuous activities may provide relief.
Surgical Intervention
For cysts causing significant pain, discomfort, or cosmetic concerns, surgical options include:
- Spermatocelectomy (removal of the cyst while preserving the epididymis)
- Epididymectomy (removal of part or all of the epididymis) in severe cases The most recent and highest quality study 2 suggests that microscopic cyst resection is a beneficial option, providing a clear vision of the subtle tissue structures of the epididymis, allowing for complete removal of the cyst with minimal bleeding and no need for wound drainage.
Recommendations
Surgical excision is the recommended treatment for symptomatic epididymal cysts, particularly for cysts larger than 1 cm in diameter or those causing persistent symptoms, as it provides a definitive treatment with minimal recurrence rates 1, 2. Conservative management is recommended for asymptomatic or mildly symptomatic cysts, with regular follow-up to monitor cyst size and symptoms. Aspiration of fluid is generally not recommended as a long-term solution due to high recurrence rates. Percutaneous sclerotherapy may be considered as an alternative to surgery, but its effectiveness and safety need to be further evaluated 3.