Epididymal Cyst

An epididymal cyst is a benign fluid filled cyst arising from the epididymis.

It commonly occurs within the epididymal head.

Unlike a spermatocele, an epididymal cyst contains clear serous fluid without significant sperm content.

The distinction has little clinical importance unless fertility preserving surgery is being considered.

Typical presentation:

• Painless scrotal lump
• Smooth cystic lesion separate from the testis

Large lesions can produce heaviness or discomfort.

The critical examination question is whether the mass is:

• Intratesticular

or

• Extratesticular

An intratesticular mass requires malignancy assessment.

Scrotal ultrasound confirms a simple extratesticular cyst.

No tumour markers or staging are required for a clearly benign epididymal cyst.

Most require no treatment.

Reassure and observe.

Operate when:

• Large
• Painful
• Functionally troublesome
• Diagnosis uncertain

Perform epididymal cyst excision while preserving surrounding epididymal tubules when fertility matters.

Discuss the potential risk of:

• Epididymal obstruction
• Reduced fertility
• Haematoma
• Recurrence

before elective excision.