What is an epididymal cyst (spermatocele)? Causes, symptoms, and the best treatment options

What is an epididymal cyst?

A spermatocele, or epididymal cyst, is a benign mass within the epididymis. The epididymis is a duct located above each testicle that is responsible for transporting and storing sperm. These cysts contain a clear or milky fluid that may also contain sperm.

Is an epididymal cyst dangerous?

These cysts are typically painless and are often discovered incidentally during medical examinations or testicular self-examination. They rarely cause serious problems and usually do not require treatment unless they become large or painful. The exact causes of spermatoceles are unknown, but they may result from a blockage in one of the epididymal ducts.

Epididymal cysts are usually free of complications, but in some cases they may twist and become very painful. In cases of torsion, sudden testicular pain develops within half an hour, and surgery may be required to resolve the torsion.

People with an epididymal cyst generally have normal fertility.

Available treatments for a spermatocele include surgery and drainage of the cyst, but these treatments become necessary only when the cyst causes symptoms in the patient.

Who develops epididymal cysts?

Middle-aged individuals are most likely to develop them. Children and adolescents are not exempt from this condition either. There are no exact statistics on the number of affected individuals, because many people are unaware of its presence.

Symptoms

Epididymal cysts usually form above or below the testicles and are typically not painful. These cysts do not become infected and do not affect fertility, urine flow, or ejaculation. Some believe these cysts arise due to a blockage in the sperm ducts behind the testicle.

Diagnosis

Diagnosing an epididymal cyst can be challenging because of the various masses near the testicle that may resemble these cysts. These masses can form for various reasons, including inflammation, hydrocele, varicocele, and lipomas. Each of these conditions has its own specific characteristics and signs that may be mistaken for an epididymal cyst on physical examination. Accurately recognizing these masses and distinguishing them from an epididymal cyst is essential for correct diagnosis and appropriate treatment.

• Inflammation: Some types of inflammation may cause the epididymis to swell, which on examination may resemble a cyst.

• Hydrocele: In a hydrocele, fluid accumulates around the testicle within the scrotum.

• Varicocele: A varicocele is a dilation of the testicular veins that may feel like a bag of worms.

• Lipoma: Lipomas are fatty masses that form near the testicle and may resemble an epididymal cyst.

To diagnose epididymal cysts, the physician usually takes a medical history and performs a physical examination. If necessary, ultrasound can be used to confirm the diagnosis. Most people who develop testicular cysts are healthy individuals, although this condition is more commonly seen in the following cases:

• Cystic fibrosis: Cystic fibrosis is an inherited disease in which cysts form within the lungs, pancreas, and other parts of the body.

• Polycystic kidney disease: An inherited disease in which cysts form inside the kidneys and other parts of the body.

Detecting an epididymal cyst by the patient

The best time to examine the testicles is during or after a warm shower. Warm water relaxes the scrotum and allows for better detection of any abnormal mass. Use the following methods to examine the testicle:

• Examine each testicle separately with both hands.

• Examine the testicles between the thumb and the fingers.

• Normally, the testicles are oval-shaped, smooth, and somewhat firm.

By performing this simple examination, you can become familiar with the characteristics of your testicles and detect any abnormal changes earlier.

Regular and systematic self-examinations can play a very important role in maintaining health. However, it should be remembered that periodic examinations by a physician are far more reliable for assessing the condition of the testicles.

Treatment of an epididymal cyst

If the cysts are small and do not cause symptoms, treatment is generally not needed. Treatment is carried out when the cysts become very large or painful. In infants, these cysts may resolve on their own over the course of years. In children as well, surgery is performed only when the cysts are very large or painful. Very large and painful cysts can be removed surgically. In some cases, at the urologist's discretion, the fluid inside the cyst is drained with a needle and syringe, and a substance is injected into the cyst to prevent recurrence.

Treatment methods

1. Surgery and removal of the spermatocele: This surgery is generally performed on an outpatient basis under general anesthesia or spinal anesthesia.

2. Drainage of the cyst with a needle and syringe (percutaneous cyst aspiration): Aspiration is a treatment method that is not very common and is sometimes performed together with sclerotherapy. In this method, a special needle is inserted into the cyst and the fluid inside it is withdrawn. The surgeon may inject an irritating chemical agent (sclerotherapy) into the cyst to reduce the chance of recurrence. One possible complication of sclerotherapy is damage to the epididymis. There is also a chance that the cyst may grow back after treatment. This method is prescribed only for older men who are past childbearing age and are not candidates for surgery.

3. Diet and supplements: A diet rich in anti-inflammatory foods can be one of the treatment methods for an epididymal cyst. Certain supplements should be included in the diet, which are:

• Iodine: One of the causes of this cyst is iodine deficiency. Using iodine as a combination therapy can reduce the size of the cyst as the iodine penetrates into it.

• Magnesium: The amount of calcium in the body affects the growth of an epididymal cyst. Magnesium supplements prevent its increase by excreting excess calcium and help regulate calcium levels.

• Chromium chloride: This substance is also responsible for regulating calcium in the body. Cysts form as a result of increased solubility of calcium in tissues and elevated blood sugar levels in tissues and bones. Chromium chloride balances calcium levels and prevents their excessive rise. Drinking plenty of water and avoiding sugar consumption greatly contribute to the effectiveness of this treatment option.

Preventing the occurrence of an epididymal cyst

Although preventing the occurrence of an epididymal cyst is not possible, regular examinations at least once a month can help identify changes such as abnormal bulges or masses in the testicles. If any abnormal mass is observed, a physician should be notified immediately.

Summary

An epididymal cyst, or spermatocele, is a benign and usually painless mass that forms in the epididymis and often does not require treatment unless it becomes large or painful.

Correct diagnosis is made through physical examination and ultrasound. Treatment methods include surgery and drainage of the cyst. In addition, consuming anti-inflammatory foods and certain supplements can be effective in reducing the size of the cyst.

Regular examinations and testicular self-examination help in the early detection of masses. By following the points mentioned, serious problems can be prevented and health can be maintained.

Frequently asked questions