From the Research
Treatment for an epididymal cyst typically begins with observation, as most cysts are benign and don't require intervention unless they cause pain or discomfort. For symptomatic cysts, over-the-counter pain relievers like ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) can help manage discomfort 1. Applying a cold compress to the scrotum for 15-20 minutes several times daily may reduce swelling and pain. Wearing supportive underwear or a scrotal support can also provide relief by minimizing movement and pressure on the cyst.
Key Considerations
- If conservative measures fail, medical intervention may be necessary, such as aspiration (draining fluid with a needle), which provides temporary relief but cysts often recur 2.
- For persistent or particularly bothersome cysts, surgical removal (spermatocelectomy) may be recommended, typically performed as an outpatient procedure under local or general anesthesia 1, 3.
- Surgery is generally reserved for cases where the cyst causes significant pain, grows rapidly, or creates uncertainty about diagnosis.
- Most epididymal cysts remain stable in size and cause minimal symptoms, making watchful waiting an appropriate approach for many patients 4, 5.
Management Approach
- Conservative management constitutes the treatment of choice in the majority of cases, and surgery is recommended only in selected cases 4.
- Approximately 50% of epididymal cysts involute within an average of 17 months, and conservative treatment of asymptomatic cysts with diameter smaller than 1 cm is proposed 1.
- Surgical excision is recommended for large asymptomatic cysts with diameter greater than 1 cm, which do not regress after a follow-up of 24-48 months, cysts, regardless of their diameter, responsible for persistent symptoms and in the manifestation of acute scrotal symptoms due to inflammation, intravesical bleeding or secondarily torsion of the epididymis 1.