The epididymis is a small organ that drapes over the back of each testicle. In the epididymis, sperm undergo some changes and are stored. A cyst can develop in one of the ducts and enlarge. A cyst is a benign (not cancerous or malignant) balloon-like structure that contains fluid. Many men have epididymal cysts, but rarely do they present a problem. In rare instances, a cyst can grow quite large and cause discomfort. In these cases, a patient may elect to have it removed.
These are often discovered by a patient during self-examination or while washing. They may be confused for testicular cancer. It is always important that any scrotal swelling be fully evaluated, including by means of a scrotal ultrasound examination. Unless they are large, it is very unusual for an epididymal cyst to cause discomfort. Others are detected by a physician during a routine examination. Many are not felt but are found during an ultrasound of the scrotum/testicles being performed for an unrelated reason.
Please refer to the detailed instructions provided by the rooms. These may also be downloaded from this website. As with any procedure in which anaesthesia is administered, you will be asked not to eat or drink anything after midnight on the evening prior to your surgery.
Excision of Epididymal Cyst Procedure
An incision is made in the scrotum. Dissection is then performed down to the testicle and epididymis. Usually, the entire testicle is delivered out of the incision so that the extent of the cyst and all of the anatomy can be carefully examined. The balloon-like cyst is then dissected away from the epididymis while preserving as much of the epididymis as possible. Sometimes, a portion of the epididymis or even the entire epididymis must be removed because separating the two may cause too much bleeding or damage to other structures. Once the cyst is removed, the incision is sutured closed. A drainage tube may also be left in place to prevent fluid accumulation within the scrotum.
You will be in the recovery room for a short time before being sent to the day surgery ward and then allowed home. You may have discomfort over the incision and possibly in the groin and scrotum. There may be a scrotal support with some gauze underneath. Occasionally there is small blood staining on the gauze or skin, and this is normal. If the dressing becomes soaked, or you see active blood oozing, please return to hospital or contact the rooms. You may shower the day after surgery, but no baths or swimming. We ask that you refrain from any strenuous activity until your follow-up. Every patient has some degree of swelling and bruising, and it is not possible to predict in whom this might be minimal or significant. We strongly encourage you to take the following day off work and perhaps more if your occupation requires strenuous activity or heavy lifting. In the first 24 hours, it is to your advantage to minimize activity and spend a lot of time lying down. The more swelling you prevent in the first two days, the better off you are. The sutures we use are self-dissolving, and therefore just fall out on their own within two to three weeks after surgery.
Expectations of Outcome
The tissues within the scrotum always swell and usually feel quite firm to the touch after swelling begins. The scrotal skin may appear very bruised as well. This is expected, and could last for a few weeks.
Possible Complications of the Procedure
Most patients experience no problems after the operation. All surgical procedures, regardless of complexity or time, can be associated with unforeseen problems. They may include, but are not limited to:
Recurrence or Persistence
A cyst may uncommonly return. It is almost always a new process and not recurrence of the already removed mass.
This is when a blood vessel continues to ooze or bleed after the procedure is over. The result is swelling and bruising. It usually resolves over time with compresses…much like any bad bruising or swelling. If the haematoma is unusually large (cumbersome or painful) or does not show resolution in a reasonable amount of time, a procedure to evacuate the clots may rarely be required.
Infection is possible in any procedure. Usually, local wound care and antibiotics are sufficient. Occasionally, an infection would require partially opening the wound to allow proper drainage.
As with any procedure, a patient can develop chronic pain in an area that has been operated on. Typically, the pain disappears over time. If persistent, further evaluation would be necessary.
This is quite unlikely, but could occur from loss of blood flow to the testicle.
Excision of an epididymal cyst may cause scarring of the epididymis. In addition, a portion of the epididymis may need to be removed in order to adequately remove the cyst. This will affect the passage of sperm cells through the epidydymis and therefore impact on fertility.
Please contact the office within 3 days of discharge. You should make an appointment to see Dr Sved as directed in the hospital. You may see him in his offices at RPA, Starthfield Private or Bankstown Hospitals. Do not hesitate to call at any time if you have any concerns.