From the Guidelines
An epididymal cyst is a benign, fluid-filled sac that develops in the epididymis, and the most recent and highest quality study suggests that these cysts are common and typically don't require treatment unless they cause discomfort or concern 1.
Diagnosis
The diagnosis of an epididymal cyst typically involves a physical examination and medical history, and may include imaging tests such as ultrasound to confirm the presence of a cyst. It's essential to have any testicular lump evaluated by a healthcare provider to rule out more serious conditions like testicular cancer, even though epididymal cysts are benign.
Treatment
If an epididymal cyst is causing pain or discomfort, over-the-counter pain relievers like ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) may help manage symptoms. For larger or symptomatic cysts, a urologist might recommend surgical removal through a procedure called spermatocelectomy, typically performed as an outpatient procedure under local or general anesthesia.
Key Points
- Epididymal cysts are common and typically don't require treatment unless they cause discomfort or concern
- Diagnosis involves physical examination, medical history, and imaging tests such as ultrasound
- Treatment options include over-the-counter pain relievers and surgical removal for larger or symptomatic cysts
- It's essential to have any testicular lump evaluated by a healthcare provider to rule out more serious conditions like testicular cancer
Recommendations
- For symptomatic epididymal cysts, surgical removal through spermatocelectomy is a recommended treatment option 1
- For patients with epididymal cysts, it's essential to follow up with a healthcare provider to monitor the cyst and address any concerns or symptoms that may arise.
From the Research
Diagnosis of Epididymal Cysts
- Epididymal cysts are benign cystic formations of the epididymis that can be diagnosed using ultrasound scanning 2
- The diagnosis is typically confirmed by physical examination and ultrasound (US) confirmation 3, 4
- Epididymal cysts can present as painless testicular enlargements on palpation and are echo-free at ultrasound examination 5
Treatment of Epididymal Cysts
- Conservative treatment is recommended for asymptomatic cysts with a diameter smaller than 1 cm 2, 6
- Surgical excision is recommended for large asymptomatic cysts with a diameter greater than 1 cm that do not regress after a follow-up of 24-48 months 2, 6
- Surgical excision is also recommended for cysts that are responsible for persistent symptoms 2, 3, 4
- Percutaneous sclerotherapy is a valid therapeutic alternative to surgery in the management of epididymal cysts, with a technical success of 100% and no complications reported 5
Management of Symptomatic Epididymal Cysts
- Symptomatic cysts can be treated with percutaneous sclerotherapy, which has been shown to be safe, effective, and free of complications 5
- Surgical excision is recommended for patients with persistent scrotal pain or an acute scrotum 3, 4
- The management of epididymal cysts in children is usually conservative, with surgical excision recommended only for patients with intractable scrotal pain or if the cyst size does not seem to involute 3, 4