What are the indications for an epididymal cyst removal?
Epididymal cysts are common and often need no treatment. Removal is generally recommended for the following reasons:
- A lump alongside the testicle that is enlarging or uncomfortable
- A feeling of heaviness or aching in the scrotum
- Interference with physical activity
- Concern about appearance through clothing
What are the alternatives?
- Observation — Suitable for small or painless cysts.
- Needle aspiration — Draining the fluid with a needle; however it usually refills quickly and can cause bleeding and infection, so not recommended as routine practice.
What happens before surgery?
You will be asked to attend for a pre-operative assessment approximately 2-3 weeks before surgery, where blood tests and an ECG are typically performed to ensure the procedure takes place with minimal risk. Most patients should continue regular medication, although certain drugs should be stopped prior to surgery. Please tell the team if you take blood thinners or have any implants, a pacemaker or a history of MRSA.
On the day of surgery you should avoid eating for six hours before, and drink only clear fluids within two hours of the procedure. You will be given a gown and compression stockings to wear, your consent will be confirmed, and an anaesthetist will discuss your anaesthetic and pain relief.
What does the procedure involve?
- Performed under general or spinal anaesthetic, usually with a local anaesthetic spermatic cord block.
- A small incision is made in the scrotum.
- The cyst is carefully separated from the epididymis and testicle and removed.
- The skin is closed with dissolvable stitches that disappear over 3-4 weeks.
- A turban dressing or scrotal support is applied at the end of the procedure.
What are the side-effects?
- Swelling, bruising and discomfort of the scrotum (almost all patients).
- Recurrence or development of further cysts (5-10%).
- A blood collection (haematoma) that resolves slowly or needs drainage (5-10%).
- Infection of the wound or testicle needing antibiotics or drainage (5-10%).
- Reduced fertility on that side from scarring of the epididymis (less than 1%).
- Injury to the epididymis, vas or blood supply, or chronic pain (less than 1%).
What happens after surgery?
Most men wake up with minimal pain due to the placement of a local anaesthetic block, which usually lasts for 6-8 hours post-op. After this you should take simple painkillers such as paracetamol if needed. You can remove the turban dressing or scrotal support after 24 hours, following which you should shower and carefully dry the area, before applying Vaseline® or E45® cream to the wound. You should wear supportive, tight-fitting underwear and avoid heavy lifting and strenuous exercise for at least four weeks.
A discharge letter will be shared with your GP and an outpatient review appointment will be made for 6-8 weeks.
Patient information leaflet
Read the British Association of Urological Surgeons (BAUS) leaflet: Removal of an epididymal cyst.
View the BAUS leaflet