Epididymal cysts – Hydrocele

Hydrocele is a collection of fluid in a sac in your scrotum next to the testis. It usually occurs on one side and rarely on both sides.

An epididymal cyst is a fluid-filled pocket that forms in the epididymis, a coiled tube in the back of the testicle that stores and transports sperm.

Most hydroceles occur in adults and are most common in men aged over 40 years.

• The cause is not known in most cases.
• A small number of hydroceles are caused when something is wrong with one of the testes like trauma,infection, inflammation, injury or tumours.
• Sometimes hydroceles develop when there is generalised swelling of the lower half of your body due to fluid retention.

The main symptom of a hydrocele is swelling on one or both sides of your scrotum. 

You might notice other symptoms in the area like:

• Swelling that changes in size during the day.
• Discomfort.
• Pain.
• A feeling of heaviness.

Your Urologist will examine you and this in most cases is more than enough to make the diagnosis.It is always advisable to do an ultrasound scan to exclude other diagnoses like hernias,tumours etc and identify, if possible, the underlying cause.

A hydrocele is not usually dangerous and will not affect fertility. In rare instances, it might link to an underlying testicular condition, such as an infection, tumour, or inguinal hernia.

They are simple cysts of the tube that carries the sperm from the testis and they are benign in nature, which means they are not cancerous.

A large hydrocele or epididymal cyst may cause discomfort while sitting or walking. However, in many people this isn’t serious, bothersome or painful.

If a hydrocele doesn’t go away on its own, the only way to correct it is to have surgery. There aren’t any medications available to reduce its size.

No, it is likely to stay stable and in some cases to grow with time.Occasionally, epididymal cysts may cause pain in the scrotum, requiring removal.

• Leaving it alone
  In adults, if they cause no symptoms, one option is simply to leave it alone. If it becomes larger or troublesome, you can always change your mind.

• Surgery
  Surgery may be recommended if it is large or uncomfortable.They may return after surgery but this is very uncommon.

• Drainage
  The fluid can be drained easily with a needle and syringe. However, following this procedure, it is common for the sac of the hydrocele to refill within a few months. Draining every now and then may be suitable if you are not fit for surgery or if you do not want an operation.It is not recommended for epididymal cysts as it can cause issues with chronic pain, subfertility and scarring of the tube that carries the sperm from the testis.

No, patients are able to return home a few hours after surgery.

It is normal to expect swelling and bruising in the scrotum. This will get worse for the first few days and then get better over the following month.
We advise patients to take a week off work and avoid strenuous physical activities for 2-3 weeks.