Epididymal cyst recurrence

[Jenss]

Hi a very close and dear gentleman to me discovered that he had a lump in his testical. It was medically diagnosed as being an epididymal cyst about twenty years ago. Regular check ups from the doctor provided that nothing had changed and that the cyst was fine to stay in its harmless form (it was causing no pain & was not cancerous etc). But in the last two years it had grown in size and was beginning to be uncomfortable. The doctor then suggested that he have it surgically removed. He did so. It then returned immediately & to an even slightly bigger size. The doctor was surprised and he surgically removed it again some months later. Now in 5 weeks of post recovery, it is clear that the cyst recurred again immediately after the operation.
1) Is this common?
2) What is the solution?
3) What are the options?
4) Is there any alternatives?
5) What are the risks associated with the solutions or options you suggest?

I appreciate your time on this issue - I am most grateful

[Dr_Veena]

Hi,
Thanks for writing in. Epididymal cysts are typically painless and harmless.  To my knowledge, there is not an association with testicular cancer.  It is possible that the trauma from sex may exacerbate the pain.  Sometimes, epididymal cysts can go away on their own.  However, if they continue to become uncomfortable, they can be surgically removed or drained.
The results of operation are more sure as it is usually possible to remove the whole cyst. The operation is usually performed using general anaesthesia but can be performed using local if preferred.  
After operation there is a small chance that further cyst may develop; it is possible to lessen this chance by removing the whole epididymis (the part of the testicle from which the cyst arise); however, the disadvantage of this is that there is more danger of damage to the blood supply to the main body of the testicle and so removal of the epididymis is usually reserved for older men who no longer wish to father children and where the cyst has come back again.  The operation is successful in about 95% of patients.
All the best.