Epididymal cysts are fluid-filled lumps that appear along the epididymis, the tube that carries sperm from the testicle. In most cases, a cyst develops at the head of the epididymis just above the testicle. Epididymal cysts are usually benign, small, and painless, and do not require medical treatment. A lesion that grows very large, however, can cause significant discomfort and embarrassment as the scrotum swells. Large cysts can be removed through fairly simple surgical procedures.
Also called spermatoceles, these cysts develop when sperm and other fluids begin to build up in the head of the epididymis. Most cysts do not have a clear underlying cause, but an infection called epididymitis or an injury to the groin region precedes them in some cases. Spermatoceles are usually very small, less than 0.5 inches (about 1.25 centimeters) in diameter. They may not even be noticeable. In some cases, however, untreated cysts can grow to be 2 inches (about 5 centimeters) across or larger.
Small cysts typically do not cause symptoms. A person may notice a small, soft lump on top of one of his testicles. Larger epididymal cysts can result in scrotal swelling, tenderness, aches, and redness. There also may be a sense of fullness or pressure at the base of the penis, and sexual activity might be uncomfortable. It is important to visit a doctor whenever an unusual lump is discovered in the scrotum to ensure a proper diagnosis.
A doctor can usually diagnose an epididymal cyst with a simple physical exam. He or she can feel the scrotum to determine the lump’s exact size and location. A light is shined through the scrotum to confirm that the mass is filled with fluid and not made up of harder tissue. If light cannot be seen through the lump, it may indicate the presence of testicular cancer or another more serious condition.
Most asymptomatic epididymal cysts do not need to be treated. They often stay very small or spontaneously go away over the course of a few weeks or months. If a spermatocele causes pain and swelling, a doctor can explain surgical treatment options. The most common procedure to remove a symptomatic cyst is called a spermatocelectomy.
During the operation, the scrotum is opened and the cyst is carefully cut out of the epididymis. The tube is then sutured and treated with antibiotics to prevent infection. Most patients who undergo spermatocelectomy are able to make full recoveries in about one month. It is possible for cysts to return or for other testicular problems to develop after surgery, so patients are encouraged to routinely examine themselves and schedule yearly doctors’ appointments to ensure reproductive health.