An epididymal cyst, often called a spermatocele, is a common non-cancerous condition affecting the male reproductive tract. This benign growth occurs in the scrotum and is typically a harmless finding, though the discovery of any lump can cause anxiety. Often, these cysts are small and cause no symptoms, being found only incidentally during an examination or self-check. Understanding the nature of this condition clarifies when medical intervention might be needed.
Defining the Epididymal Cyst
An epididymal cyst is a fluid-filled sac that develops within the epididymis, the long, coiled tube situated behind and above the testicle. The epididymis stores and transports sperm cells produced by the testicle. A spermatocele is the specific name given when the cyst fluid contains sperm cells, often appearing milky or cloudy.
The precise cause is not always clear, but formation is thought to result from a blockage or dilation of the tiny ducts within the epididymis. This obstruction causes fluid to accumulate in a localized pouch, forming the cyst. These cysts are common, affecting an estimated 30% of men, and can vary in size from a few millimeters to several centimeters.
Symptoms and How They Are Detected
Most epididymal cysts are asymptomatic, meaning they do not produce noticeable symptoms and are discovered accidentally. Individuals may find the mass during a routine testicular self-examination or a physical examination. The typical presentation is a smooth, distinct lump or mass located above or behind the testicle, and it usually feels separate from the testis itself.
If the cyst grows large, it may cause mild symptoms, such as a feeling of heaviness or general discomfort in the scrotum. Sharp pain is uncommon unless the cyst twists on itself, which is a rare event. The presence of a spermatocele does not affect the ability to urinate or ejaculate, nor does it interfere with fertility.
Diagnosis and Ruling Out Other Conditions
The primary goal of a medical evaluation is to confirm the fluid-filled nature of the lump and differentiate it from more concerning conditions, particularly testicular cancer. The process begins with a physical examination, where the doctor manually checks the size, location, and texture of the mass to confirm it is distinct from the testicle.
A simple, non-invasive technique called transillumination is often performed, which involves shining a light through the scrotum. Since the epididymal cyst is fluid-filled, the light passes through and illuminates the mass. A solid mass, like a cancerous tumor, would block the light, helping distinguish a fluid-filled lesion from a solid mass.
To confirm the diagnosis definitively, a scrotal ultrasound is the standard imaging tool. Ultrasound provides a clear image, showing the precise location, size, and fluid-filled (anechoic) nature of the cyst. This imaging is crucial for distinguishing an epididymal cyst from a hydrocele, which is a collection of fluid that surrounds the entire testicle.
Management and Treatment Options
Because epididymal cysts are benign and often cause no problems, the standard approach to management is “watchful waiting” or observation. No treatment is necessary if the cyst is small and does not cause pain or discomfort. Regular self-exams and follow-up appointments may be recommended to monitor the cyst for changes in size.
Intervention is usually reserved for cysts that cause significant pain, grow large enough to cause bother, or interfere with daily activities. The main surgical treatment is a procedure known as spermatocelectomy, which involves surgically removing the cyst from the epididymis. This procedure is generally effective at resolving the issue.
Another option is aspiration, which involves draining the fluid from the cyst with a needle. This may be followed by sclerotherapy, where a chemical is injected to prevent fluid reaccumulation. However, aspiration alone is associated with a high rate of recurrence. Surgical removal remains the most definitive option for symptomatic cysts, though it carries a small risk of epididymal injury or recurrence.