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Epididymal cyst or epididymal mass is sometimes also named spermatocele. Some might say that spermatocele and epididymal cysts are not the same, but the only difference is the presence of sperm in spermatocele.

Besides epididymal cyst or epididymal mass, there are a few other types of scrotum cysts: spermatocele, Tunica vaginalis cyst, hydrocele and paratesticular abscess, and they are briefly described below: 

Spermatocele – there is a really small difference between epididymal cyst and spermatocele. They are both benign asymptomatic lumps on testicles. They have the same clinical presentation and treatment options. The only difference is the presence of dead sperm cells in the fluid contained inside of spermatocele.

Tunica vaginalis cyst is another type of benign cyst which can be found in male's scrotum. It is a paratesticular cyst, which means that it is found outside of testicles but attached on its sheet. Some claim that there is a link between trauma or bleeding and tunica vaginalis cyst. It is a benign formation and it can be differentiated from epididymal cyst with help of ultrasound.

A hydrocele can be easily differentiated from the epididymal cyst. Hydrocele causes fluid accumulation around both testicles. That causes swelling of scrotum which is seen just by looking. Ultrasound is not needed for diagnosis, a physical examination and translumination are enough to make a diagnosis.

A paratesticular abscess occurs when there is an infection of scrotum or testicles. The main symptoms are redness of scrotum, pain, swelling. In some cases, symptoms can mimic symptoms of torsion of testicle. The main treatment option is antibiotics and in some cases surgical treatment.   

An epididymal cyst is a benign cyst, and it is very spread in the general population. Almost every third male has an epididymal cyst, and most aren't aware because it shows no symptoms. An epididymal cyst is rare in children, and it is the most common in middle-aged males.

The most common origin of epididymal cysts is lymphatic [2]. Most epididymal cysts contain lymphocytes, fluid, spermatozoa and cellular debris.

Epididymal cysts and complications

The epididymal cyst will not cause cancer. It doesn't matter how long do you have it, one day or several years, it will never lead to cancer.

One of the most dangerous complications of epididymal cyst is torsion or twisting of the cyst. In case it happens, it will result in sudden onset of severe pain and swelling of the scrotum. This complication requires urgent medical attention and surgery.  Luckily torsion of epididymal cyst is rare. [3] 

Also, there is no risk of infection of epididymal cyst even if it is untreated for a longer period.[4].

There is no evidence that epididymal cyst causes erectile dysfunction.

Causes of epididymal cysts

It is not clear what causes epididymal cysts. Some say that the cause lies in an abnormal expansion of epididymis or distal obstruction.

Epididymal cysts are the most common in the population of males, which create prolonged pressure on their testicles. Mountain bikers are one category of males with a higher risk of developing epididymal cysts [5].

Diagnosis

Doctors easily diagnose epididymal cysts with a combination of physical examination and ultrasound. They are often diagnosed as accidental finding after physical examination and ultrasound. Almost every third patient, which was diagnosed with epididymal cyst has at least two of them [6].   

Epididymal cyst on ultrasound is presented as a well-defined black (anechoic) area. If it is a larger cyst, it can move the testis.

It is important to distinguish an epididymal cyst from other types of cysts which can be encountered in the scrotum (spermatocoele, tunica vaginalis cyst, hydrocoele) and paratesticular abscess.

Symptoms

Most patients don't have any symptoms or they complain about palpable mass which doesn't hurt. It causes swelling of testes and sometimes it can be reddish.

Therapy

Since most of epididymal cysts don't have any symptoms besides the presence of scrotal mass, most patients decide not to treat it. It should be treated in case it creates symptoms such as pain or discomfort or if the cyst increases in size over a short period of time. Two main treatment methods are surgical removal and sclerotisation.

Surgical removal will remove the epididymal cyst completely. In case of sclerotization, sclerosing agent is injected into cyst after the content of the cyst was removed with the help of syringe and needle [7].

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