They are regular, painless and benign swellings, which may be single or multiple, located in the upper and posterior area and are of unknown origin.
The majority of testicular cysts are benign pathologies but they need a differential diagnosis with respect to cancerous tumors.
This is an injury filled with water and surrounded by a tissue that prevents it from coming out, but with the ability to involute and disappear.
They can have a considerable size, and even reach sizes greater than those of the testicle itself.
The epididymis is a tubular and coiled structure that is located behind the testicles. When it is filled with fluid, it is called an epididymal cyst.
The causes of epididymal cysts are unknown, but they usually develop as a result of the accumulation of sperm or some other fluid in the upper part of the epididymis.
The epididymal cyst, because it is asymptomatic, is usually discovered through a routine examination and, at other times, it can be manifested by pain in the scrotum, mild but continuous.
When there are complications such as hemorrhage or torsion, where there is a pattern of acute pain comparable to the twisting of the testicles.
There may be an increase in the volume of the scrotum , which produces the sensation of having a ball inside, usually accompanied by local discomfort.
A physical examination is performed to feel the size and position of the cyst inside the testicles, being able to verify if there is swelling and sensitivity and determine if the mass is full of liquid or a more solid tissue.
Most testicular cysts are diagnosed during a physical examination, but to confirm the diagnosis, other tests must be performed.
Tests may include:
- Ultrasound or ultrasound, which presents an image of your testicles, scrotum and abdomen.
- Blood tests in which the presence of tumor cells, infections or other signs are studied.
- Histological examinations through tissue extraction and analysis, which will show the nature of the cyst to differentiate it from the presence of a cancerous tumor .
- STD exam by serology, diagnoses of HIV, Hepatitis B, Syphilis and through the culture of urethral or vaginal exudate the diagnoses of Gonorrhea , Ureaplasma, Clamideas and Trichomonas.
Although the epididymal cyst presents no risk, it is necessary to make the correct differential diagnosis that corroborates the presence of an anechoic lesion of completely liquid content, of a benign nature.
The diagnosis has to be made primarily with respect to tumors and spermatoceles cysts.
Spermatoceles usually appear after the puberty stage, and are macroscopically and sonographically similar to epididymal cysts.
However, by means of puncture and aspiration it is possible to obtain a creamy and milky liquid, with sperm inside.
Solid tumors such as leiomyomas, neurofibromas, mesotheliomas and other sarcomas, sonographically and clinically resemble epididymal cysts.
Usually when the epididymis cysts are small, the behavior of the treatment is observational and do not need operation. It can be treated with analgesics and physical therapy.
In cases in which the cysts are very voluminous and become painful as a result of torsional ischemia, excresis is recommended .
When an excresis is performed, an intravenous sedation is used, an incision is made in the skin of the testicle, in the area where the cyst is palpated and the scrotum is opened. Once identified, the cyst is carefully separated from the epididymis and all neighboring vessels are cauterized.
The cyst is reserved for further study of pathology and the skin of the scrotum is closed with stitches. It is complemented with a treatment with antibiotics to prevent infection.
Another treatment used is puncture and aspiration with excellent results. Normally this is a diagnostic test that consists in the extraction of a total or partial sample of tissue to be examined under a microscope by a pathologist.
In few cases the partial epididymectomy is performed, or recession of the patient’s epididymis, the anesthesia is local, especially in the cases of torsion accompanied by partial necrosis of the epididymis.
Most cysts of the epididymis do not require treatment because over time, in a few months, they finally disappear.
So if the cyst causes persistent pain, the management of this problem is surgical and relatively simple, with rapid recovery.