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Epididymal cyst: What should we deal with it?

Epididymal cyst
FB Dr Soarawee
Soarawee Weerasopone, MD

Andrologist
Royal Phnom Penh hospital, Kingdom of Cambodia

Epididymal cyst is one of the most common testicular-related issues at my urology office. It was defined as an encysted structure closures the epididymitis which is literally described as a result from prior injuries or inflammations of the epididymis tubule. There’re confirmed evidences that spermatozoa or seminal fluid are the liquid which is lying inside the the cyst. These meaning that epididymal cyst are absolutely a benign lesion.

Epididymal cyst: What should we deal with it?
The symptom will usually present as incidentally self-examination painless scrotal swelling during taking a shower.

Natural history of Epididymal cyst

The symptom will usually present as incidentally self-examination painless scrotal swelling during taking a shower. While it always been asymptomatic, so there was 20 – 40% incidentally reported from scrotal ultrasound. The natural history can be something varied from spontaneous resolution, stable or slow growing over times. When mostly they were asymptomatic, so it is highly recommended that, do not digging out any intervention with any sizeable of asymptomatic epididymal cyst. There have been some literatures suggested that epididymal cyst which less than 10 mm can be safely managing as conservative treatment.

Less than 1 cm is safe
Less than 10 mm epididymal cyst can be managed conservatively.
Scrotal pain
Sometimes epididymal cyst can express as scrotal discomfort.

A very interesting, randomized trial from India since 2019, they studied various treatment modalities in a different size of the cysts and here are the recommendations.

  1. < 10 mm
    • Conservative treatment with possibility of 95% natural resolution within 3 years.
  2. 11 – 20 mm
    • Conservative treatment with possibility of 66% natural resolution within 3 years.
    • Needle aspiration is recommended in symptomatic patients.
  3. 21 – 50 mm
    • 0% of natural resolution within 3 years
    • Needle aspiration is recommended in symptomatic patients.
    • Surgical excision is the last choice due to risk of infertility
If more than 2 cm
Surgical excision will be considered in > 2 cm symptomatic epididymal cyst.

All I can say is, don’t be panic with the cyst. See you in next article!

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