Epididymal cyst: symptoms, diagnosis and treatment

The epididymis is a coil-like tube behind each testicle that helps store and transport sperm. NHS inform describes an epididymal cyst as a small, smooth fluid-filled swelling that slowly develops in the epididymis. Patient (a UK health information site) describes it as a harmless growth in the tubes that carry sperm, and notes a cyst is simply a bulge filled with fluid.

The BNSSG Healthier Together guidance describes epididymal cysts as forming when fluid builds up in the epididymis, and states they are harmless and not a sign of testicular cancer.

Patient says an epididymal cyst usually presents as a soft, slightly squidgy lump at the top or bottom of the testicle. It is not usually painful and will not affect your ability to exercise, pass urine or ejaculate. The Devon referral guideline says they are usually asymptomatic but may cause some anxiety, and that pain, where present, is usually a mild ache or discomfort in the scrotum.

Patient says men are most likely to develop these cysts in middle age and that children rarely get them before they become teenagers. It is hard to give a percentage because most people who have them do not know.

NHS inform sets out when to seek help for lumps and swellings in the testicles.

• Phone 999 or go to A&E for sudden, severe pain in a testicle, testicle pain with feeling sick, being sick or tummy pain, or testicle pain that has lasted more than an hour or continues when you are resting. These can be signs of a serious problem needing hospital treatment as soon as possible.

• Contact your GP practice urgently for a lump in your testicles, swollen testicles, a change in shape or feel, 1 testicle that has become bigger than the other, or aching or discomfort that does not go away.

• The Devon guideline says patients should seek medical advice if a cyst becomes painful or suddenly starts increasing in size, and that acute scrotal pain and tenderness may indicate testicular torsion or a strangulated hernia and is a surgical emergency.

NHS inform says there is no single test for testicular lumps and swellings. A doctor will discuss your situation and carry out a physical examination: looking at and feeling your testicles, shining a torch through the scrotum to check for fluid, referring you for an ultrasound scan, and taking a urine sample if infection is suspected.

The Devon guideline says diagnosis can usually be made on history and examination, and that an ultrasound scan is indicated in cases of diagnostic uncertainty. Patient says doctors may arrange an ultrasound even if they are fairly sure it is a cyst, for reassurance.

NHS inform says the vast majority of testicular lumps and swellings are caused by non-cancerous conditions, and most may not need treatment, but lists a range of possible causes. The Devon guideline describes how the main look-alikes differ.

Usually no. Patient says if the cyst is small and causing no pain or discomfort, all you need to do is keep an eye on it and see a doctor if it increases in size. The Devon guideline says epididymal cysts are common and rarely require treatment.

Large or painful cysts can be surgically removed or treated by aspiration and injection of a substance to shrink and seal the cyst, according to Patient. The Devon guideline says the key referral criteria are a significant impact on quality of life, a size greater than 10 mm and ultrasound confirmation of the diagnosis, because surgical treatment for smaller cysts may have a higher risk than benefit as symptoms are less likely to be cyst related.

NHS inform says that if a lump or swelling is painful or very big, your doctor may refer you to a specialist for an operation to drain, shrink or remove it, done under local or general anaesthetic depending on the procedure, and that painkillers such as paracetamol can ease discomfort.

Removal is not always funded on the NHS. For example, the BNSSG Healthier Together page says treatment for epididymal cysts is not routinely funded by that integrated care board and is subject to a restricted policy with prior approval. Policies differ between areas, so ask your GP what applies where you live.

Patient says children rarely get epididymal cysts before they become teenagers. Where a child does have one, children do not usually need treatment because most cysts disappear by themselves, although it may take up to four years to resolve. Surgical removal may be necessary if they become painful or do not start to shrink.

Any new lump, swelling or pain in a child's scrotum should be assessed promptly.

Patient says epididymal cysts usually do not cause any problems, but occasionally they can twist around (torsion) and become very painful, quickly, within about half an hour, and usually need surgery to untwist and remove them.

Patient says males who have epididymal cysts are not at increased risk of infertility if they are otherwise well, and it should not affect your ability to have children. It notes rare associations with cystic fibrosis and polycystic kidney disease.

On the NHS, a GP examines the lump and may arrange an ultrasound scan to confirm the diagnosis, then refer to urology only if the cyst is troublesome. Some people pay for a private scan or removal, particularly because NHS funding for removal is restricted in some areas. Whichever route you choose, a new testicular lump should always have a proper examination first.