While often harmless, these cysts can cause discomfort. For those experiencing symptoms, various options are available to manage and treat them, providing relief.
What is an Epididymal Cyst?
An epididymal cyst is a benign, fluid-filled sac that develops within the epididymis. The epididymis stores and transports sperm from the testicles. These cysts are a common scrotal finding, varying in size from a few millimeters to several centimeters. They are filled with clear fluid, though some may contain sperm, in which case they are referred to as spermatoceles.
The exact cause of epididymal cysts is often unknown, but they may result from an obstruction in the small tubes within the epididymis, leading to fluid accumulation. Inflammation, infection, or physical injury to the scrotum or testicles have also been suggested as contributing factors. Many individuals with epididymal cysts experience no symptoms, discovering them incidentally during physical examination or self-inspection. When symptoms occur, they can include a palpable lump, heaviness or pressure in the scrotum, mild discomfort, or swelling.
When Treatment Becomes Necessary
Diagnosis of an epididymal cyst typically begins with a physical examination, where a medical professional feels for lumps or swelling in the scrotum. Transillumination, shining a light through the scrotum, helps distinguish a fluid-filled cyst from a solid mass. An ultrasound of the scrotum confirms the diagnosis and rules out other conditions, such as testicular cancer or hydrocele, providing a clearer image of internal structures. The ICD-10 code for an epididymal cyst is N50.4.
Most epididymal cysts do not require intervention, particularly if small and asymptomatic. Treatment becomes necessary when the cyst causes significant symptoms that interfere with daily life. This includes persistent pain, substantial discomfort, heaviness, or a large size causing cosmetic concern. If the cyst grows to a size comparable to the testicle or causes a dragging sensation, intervention may be recommended.
Approaches to Managing and Treating Epididymal Cysts
For many individuals, the initial approach to an epididymal cyst is watchful waiting. This involves regular monitoring of the cyst, especially if small and asymptomatic. Many cysts do not grow or may decrease in size over time as the body reabsorbs fluid. This conservative management avoids unnecessary procedures and allows for observation of any changes.
When symptoms such as pain or discomfort arise, symptomatic management can provide relief. Over-the-counter pain relievers, like acetaminophen or ibuprofen, alleviate mild pain. Wearing supportive underwear or an athletic support reduces discomfort and swelling by providing gentle compression and elevation. These measures aim to manage symptoms without directly addressing the cyst itself.
Surgical excision, known as epididymectomy or spermatocelectomy, is the main treatment option for symptomatic epididymal cysts. This procedure involves a small incision in the scrotum, typically under general anesthesia, to carefully remove the cyst from the epididymis. The CPT code for a unilateral epididymectomy is 54860. The surgeon dissects the cyst, ensuring complete removal, and closes the incision with dissolvable stitches. Surgical excision is generally effective in relieving symptoms.
However, potential risks include bleeding, infection, pain, swelling, and in rare cases, damage to the epididymis or vas deferens, which could affect fertility. While recurrence after complete surgical removal is low, it is still possible.
Sclerotherapy is a less common alternative where a chemical solution is injected into the cyst to scar and collapse. While less invasive than surgery, sclerotherapy for epididymal cysts has a higher recurrence rate than surgical excision. It also carries potential complications, making it less frequently recommended as a definitive treatment.
Recovery and Outlook After Treatment
Following surgical excision of an epididymal cyst, patients typically return home on the same day as the procedure. Pain and discomfort are common for a few days to a week after surgery, managed with prescribed or over-the-counter pain relievers. Swelling and bruising of the scrotum usually subside within a week or two, though complete resolution can take several months.
Activity restrictions are advised to aid in healing. Patients are recommended to avoid strenuous activities, heavy lifting, and sexual activity for about two weeks post-surgery. Wearing supportive underwear helps reduce swelling and provide comfort during recovery. Most individuals experience full recovery and significant symptom relief after successful surgical removal. While recurrence is possible, it is generally low after complete excision.