From the Guidelines
Epididymal cysts and spermatoceles are both benign scrotal masses that can be managed conservatively, with surgical intervention reserved for cases causing significant symptoms or distress, as their distinction is primarily important for academic purposes and does not affect fertility 1.
Key Differences
- Epididymal cysts contain clear, serous fluid and develop from the epididymal tubules
- Spermatoceles contain milky fluid with sperm and form specifically at the head of the epididymis
Clinical Presentation
- Both present as painless, smooth, mobile swellings near the testis that transilluminate well
- Diagnosis typically involves physical examination, ultrasound, and occasionally transillumination testing
Management
- Conservative management includes scrotal support, anti-inflammatory medications like ibuprofen (400-600mg three times daily for acute discomfort), and reassurance
- Surgical intervention (spermatocelectomy or epididymal cystectomy) is reserved for cases causing significant pain, enlargement, or psychological distress
Fertility Considerations
- Both conditions are benign and do not affect fertility, though patients should be informed that surgical intervention carries a small risk of affecting sperm transport 1
Diagnostic Evaluation
- Scrotal ultrasound can be used to confirm the presence of varicocele and determine procedural success in the context of shared decision-making with the patient
- Clinicians should not perform transrectal ultrasonography (TRUS) or pelvic MRI as part of the initial evaluation of the infertile male, unless there is suspicion of ejaculatory duct obstruction (EDO) 1
From the Research
Epididymal Cyst vs Spermatocele: Key Differences
- Epididymal cysts and spermatoceles are two types of scrotal cysts that can present with similar symptoms, but they have distinct characteristics and treatment options 2, 3.
- Epididymal cysts are typically filled with clear fluid and can be solitary or multiple, while spermatoceles are filled with a milky fluid and contain sperm 3.
Diagnosis and Treatment
- Diagnosis of epididymal cysts and spermatoceles is typically made through physical examination and confirmed by ultrasound (US) 2.
- Treatment options for epididymal cysts and spermatoceles include conservative management, surgical excision, and aspiration and sclerotherapy with alcohol 2, 3, 4.
- Microsurgical epididymal cystectomy has been shown to be a safe and effective treatment for epididymal cystic lesions in young men with fertility requirements, with no significant impact on sperm count, motility, or morphology 3.
- Aspiration and sclerotherapy with 100% alcohol has also been shown to be a reliable and effective technique for treating benign scrotal cysts, including spermatoceles and epididymal cysts 4.
Symptoms and Outcomes
- Common symptoms of epididymal cysts and spermatoceles include scrotal mass and pain 2, 3.
- Treatment outcomes for epididymal cysts and spermatoceles can vary, with some patients experiencing complete involution of the cyst, while others may require surgical excision or repeated aspiration and sclerotherapy 2, 3, 4.
- The rate of complications for microsurgical epididymal cystectomy and aspiration and sclerotherapy with alcohol is relatively low, ranging from 6-7.3% 3, 4.