Epididymal Cyst & Spermatocele
Epididymal cysts and spermatoceles are common fluid-filled lumps that arise next to the testicle. Many require no treatment, but a new or changing scrotal lump should be properly assessed to confirm where it is arising from and whether further investigation is appropriate.
What is an epididymal cyst?
The epididymis is a small coiled structure attached to the back of each testicle and forms part of the pathway through which sperm travel. Fluid-filled cysts can develop within or adjacent to this structure.
Epididymal cyst
An epididymal cyst is a fluid-filled cyst arising from the epididymis. It may be noticed as a smooth lump above, behind or separate from the testicle.
Spermatocele
A spermatocele is a similar cyst arising from the epididymis whose fluid contains sperm. In practice, epididymal cysts and spermatoceles can feel similar and their management is often based primarily on symptoms and individual circumstances.
Is an epididymal cyst testicular cancer?
A confirmed epididymal cyst or spermatocele is a benign condition. However, it is not advisable to assume that every scrotal lump is an epididymal cyst. A new lump, change in the testicle or unexplained scrotal swelling should be medically assessed.
What might you notice?
Some epididymal cysts are discovered incidentally and cause no symptoms. Others become noticeable because of their size or position.
A scrotal lump
A smooth lump may be felt above or behind the testicle rather than within the testicle itself.
Heaviness or fullness
Larger cysts can produce a sensation of scrotal fullness, asymmetry or heaviness.
Discomfort
Some men experience aching or discomfort, particularly when the cyst becomes larger. Pain may also have another cause, so this needs to be assessed individually.
How is an epididymal cyst or spermatocele assessed?
The first priority with a scrotal lump is determining whether the abnormality is arising from the testicle itself or from structures around it.
History
This includes when the lump was noticed, whether it is changing in size, whether there is pain, previous scrotal surgery or infection, and whether future fertility is important.
Examination
Examination helps determine whether the lump appears separate from the testicle and whether another condition may be present.
Scrotal ultrasound when indicated
Ultrasound may be used when the diagnosis is uncertain, the testicle cannot be adequately examined, or there are features that require further assessment.
Sudden severe testicular pain is different
Sudden severe testicular or scrotal pain requires urgent medical assessment. Conditions such as testicular torsion can be time-sensitive and should not be assumed to be caused by a cyst.
Does an epididymal cyst need to be removed?
Not necessarily. Treatment depends on whether the diagnosis is clear, the degree of symptoms, cyst size and progression, fertility goals and individual preferences.
Observation
If a cyst has been appropriately assessed and is not causing significant symptoms, observation may be reasonable.
- No surgery simply because a cyst is present
- Review if symptoms or the lump change
- Further investigation if the diagnosis becomes uncertain
Surgical removal
Surgery may be discussed when symptoms attributable to the cyst become sufficiently troublesome to justify the risks of an operation.
- Persistent discomfort associated with the cyst
- Bothersome size, heaviness or mechanical symptoms
- Progressive enlargement in selected circumstances
- Individual preference after discussion of benefits and risks
There is no single cyst size that automatically means surgery.
A large cyst that causes little difficulty may not need treatment, while a smaller cyst can occasionally be troublesome because of its position. The decision is therefore based on symptoms, examination, fertility considerations and the expected balance of benefits and risks rather than size alone.
Discuss your optionsEpididymal cyst surgery and fertility
Fertility is an important consideration before epididymal surgery. The epididymis forms part of the sperm transport pathway, and surgery to separate a cyst from it can potentially cause scarring, obstruction or injury.
Planning future children?
If future fertility is important, this should be discussed before deciding on surgery. The relevance is particularly important when cysts are present on both sides, when there has been previous epididymal or testicular surgery, or when fertility is already a concern.
What does epididymal cyst surgery involve?
Surgical removal is generally performed through an incision in the scrotum. The cyst is identified and carefully separated from the epididymis before the incision is closed.
The exact operative and anaesthetic plan depends on the cyst, examination findings, previous surgery and the patient's individual circumstances.
Potential risks can include:
Bleeding or swelling
Bruising, swelling or collection of blood within the scrotum can occur following surgery.
Infection or wound problems
As with any operation, infection and wound-related complications are possible.
Recurrence
A cyst can recur or another epididymal cyst can develop later.
Persistent discomfort
Removal of a cyst does not guarantee that scrotal discomfort will resolve, particularly when pain has more than one possible cause.
Epididymal injury
Surgery can cause scarring or obstruction of the epididymis and may therefore have implications for fertility.
Further treatment
Occasionally additional assessment or treatment may be required depending on recovery or subsequent symptoms.
When should a scrotal lump be checked?
Arrange medical assessment if you notice:
- A new lump in or around a testicle
- A change in the size, shape or consistency of a testicle
- A lump that appears to be increasing in size
- Persistent scrotal aching, discomfort or heaviness
- Scrotal swelling where the cause is uncertain
- A previous diagnosis that no longer seems consistent with your symptoms
Seek urgent medical care for sudden severe pain
Sudden severe testicular pain, particularly when associated with swelling, nausea or a change in testicular position, requires urgent medical assessment rather than a routine appointment.
Other causes of a scrotal lump or swelling
Not every scrotal lump is an epididymal cyst. Other conditions may require a different investigation or treatment pathway.
Epididymal cyst & spermatocele FAQs
Is a spermatocele the same as an epididymal cyst?
They are closely related. Both are cystic lesions arising from the epididymis. A spermatocele contains sperm within its fluid, whereas an epididymal cyst generally contains clear fluid. From a patient's perspective they can present very similarly.
Can an epididymal cyst turn into cancer?
A confirmed epididymal cyst is benign and is different from a testicular tumour. The important issue is ensuring that a newly discovered lump has been correctly assessed rather than assuming that it is a cyst.
Does a spermatocele need treatment?
Many do not. If the diagnosis is clear and the spermatocele is not causing troublesome symptoms, observation may be appropriate. Intervention is generally considered when the impact of the cyst justifies the potential risks of treatment.
How big does an epididymal cyst need to be before surgery?
There is no single size at which surgery becomes mandatory. Symptoms, progression, examination findings, fertility goals and individual preferences are generally more useful than a size measurement alone.
Can an epididymal cyst cause pain?
It can be associated with aching, heaviness or discomfort, particularly when larger. However, scrotal pain can have several causes, so it is important to determine whether the cyst is actually responsible before considering surgery for pain.
Does a spermatocele affect fertility?
A spermatocele itself will often have little or no effect on fertility. Surgery is a separate consideration because operating on the epididymis can potentially cause scarring or obstruction of the sperm transport pathway.
Do I need an ultrasound?
Not every clearly benign extra-testicular lump requires the same investigation. Ultrasound may be appropriate when the diagnosis is uncertain, the testicle cannot be adequately examined or there are clinical features that require clarification.
Should I be worried about a new testicular lump?
A new lump should be assessed rather than self-diagnosed. Epididymal cysts are one common benign explanation, but lumps arising within the testicle require a different assessment pathway.
Have you noticed a scrotal lump or been diagnosed with an epididymal cyst?
A consultation can clarify the diagnosis, whether further investigation is appropriate and whether observation or treatment should be considered in your circumstances.