Epididymal cysts are fluid-filled sacs that form in the epididymis, which is the small tube behind the testicle that stores and carries sperm. Fluid-filled cysts can form from these tubes; when a cyst contains sperm it is called a spermatocele. These lumps are common, benign and usually painless and rarely need intervention after clinical and ultrasound assessment. Surgery to remove the cyst (epididymal cystectomy or spermatocelectomy) is reserved for cysts that are large, growing or genuinely troublesome.
TREATMENTS
Epididymal Cyst Excision
When Is Surgery Recommended?
Because most cysts cause no harm, we recommend excision only when the cyst is clearly the source of ongoing problems, such as:
• A persistent ache, heaviness or dragging discomfort clearly related to the cyst
• A large or steadily enlarging cyst that is uncomfortable in clothing, during exercise or during sex
• Fluid that has re-accumulated after previous needle drainage, which commonly refills and carries a risk of infection
Treatment Options
• Observation: safe for most cysts, with review if the lump grows or becomes painful
• Surgical excision: through a small scrotal incision, the cyst is carefully separated from the epididymis and removed, with dissolving stitches to close
• Aspiration with or without sclerotherapy: needle drainage is simple but the cyst usually refills, so it is rarely recommended.
It is not recommended if you are considering having children, as operating on the epididymis can affect sperm transport on that side, so we would often recommend delaying until your family is complete.
Risks and Considerations
All procedures carry risks, which your surgeon will discuss with you in detail. These may include:
• Scrotal bruising, swelling and haematoma (a collection of blood), which occasionally needs further surgery
• Wound or scrotal infection
• Recurrence of the cyst, or new cysts forming in the future
• Damage to the epididymis or sperm tube that can reduce fertility from that side
• Chronic scrotal pain, which is uncommon but can persist after any scrotal operation
Recovery at a glance: Day surgery under general anaesthetic; supportive underwear and light duties for 2 weeks, with most men back at work within about a week and returning to sport or heavy lifting after 2-4 weeks.
1
Assessment
Examination and a scrotal ultrasound confirm the lump is a simple epididymal cyst or spermatocele and exclude other causes; we then discuss honestly whether surgery is worthwhile for you.
2
The Procedure
Through a small incision in the scrotum under general anaesthetic, the cyst is freed from the epididymis and removed in a short day-case operation.
3
Recovery
Scrotal support, simple pain relief and a few quiet days at home keep swelling to a minimum. The stitches dissolve on their own over a few weeks.
4
Follow-Up
We review the wound and your symptoms, confirm the tissue result (these cysts are almost always benign) and ensure all questions are answered.
Our Approach
