Epididymal Cyst: Causes, Symptoms, Diagnosis and Treatment

They are chronic, painless, and benign swellings, which may be single or multiple, located in the upper and posterior area, and are of unknown origin.

Most testicular cysts are benign pathologies but need a differential diagnosis concerning 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 more significantly than the testicle.


The epididymis is a tubular and coiled structure 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 due to the accumulation of sperm or some other fluid in the upper part of the epididymis.


Because it is asymptomatic, the epididymal cyst 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, there is a pattern of acute pain comparable to the twisting of the testicles.

An increase in the scrotum volume may produce 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, verify if there is swelling and sensitivity, and determine if the mass is full of liquid or more solid tissue.

Most testicular cysts are diagnosed during a physical examination, but other tests must be performed to confirm the diagnosis.

Tests may include:

  • Ultrasound presents an image of your testicles, scrotum, and abdomen.
  • Blood tests study the presence of tumor cells, infections, or other signs.
  • Histological examinations through tissue extraction and analysis 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 the utterly liquid content of a benign nature.

The diagnosis has to be made primarily concerning tumors and spermatoceles cysts.

Spermatoceles usually appear after puberty and are macroscopically and sonographically similar to epididymal cysts.

However, using 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 does not need an operation. It can be treated with analgesics and physical therapy.

In cases where the cysts are very voluminous and become painful due to torsional ischemia, excretion is recommended.

When an excess is performed, intravenous sedation is used, and 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 pathology study, and the scrotum’s skin is closed with stitches. It is complemented with treatment with antibiotics to prevent infection.

Another treatment used is puncture and aspiration, with excellent results. Usually, this diagnostic test consists of extracting a total or partial sample of tissue to be examined under a microscope by a pathologist.

In a 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.