Epididymal cysts

[Astra457]

I first had a problem about 3 months ago when I started feeling sharp pains in what I now know is my epididymis.  I was misdiagnosed with epididymitis and then prostatitis by a few different doctors, including a urologist.  Eventually I went to get a second opinion at another urologist and he found a cyst in my left epididymis.  They ordered an ultrasound and verified that there was a cyst in my left epididymis and a smaller one in my right.  I've been having sharp and aching pains in my epididymis, on and off, this entire time.  Sometimes there is no pain at all, sometimes there is so much pain I can't stand it.  The pain is on both sides and when it really hurts it seems to spread/shoot out to the rest of the epididymis and even into my abdomen when it really hurts.  The other day, I had to run a long distance through the rain and shortly after I would have such great pain when walking that it spread throughout my entire left pelvic area, though it definitely hurt a LOT in the epididymis.  I've been worried that this may be a bacterial infection, but I was on Doxycycline for 1 &1/2 weeks, then Bactrim for 2 weeks, then Cipro for 2 weeks, when I was dealing with the first group of doctors.  Also, my new urologist says I definitely don't have prostatitis and he checked my prostate and said there was no swelling and it felt perfectly normal.  My previous urologist didn't do ANY tests other than a urine sample, but still diagnosed me with prostatitis.  I also started worrying that this could be chronic epididymitis, but I think the doctors would have been able to see that within the physical exam and certainly within the ultrasound, right?

I guess my main question is, can epididymal cysts create this much pain?  Can it come and go like this?  How long can I expect to have this pain?  Sometimes it just aches a little bit, sometimes it hurts like heck and really gets in the way of day to day life.  I don't want to remove it, also, because I haven't had children yet and I'm worried about sterility problems.  The cyst isn't incredibly large, either.  It is on/in the head of the epididymis and it makes the epididymis feel hard and it can hurt to touch it sometimes.  Taking warm baths can help with the pain, but tylenol or ibuprofen really doesn't seem to make any difference at all.

Thank you in advance for your help!

[Kevin Pho, MD]

Hello - thanks for asking your question.

Please understand my limitations over the internet as I have neither met nor examined you. This information is for patient education only. Please see your personal physician for further evaluation.

Epididymal cysts are commonly palpated in the head of the epididymis and are generally asymptomatic. They occur with increased frequency in male offspring of mothers who used diethylstilbesterol during pregnancy. These are usually not mistaken for other scrotal pathology, and they can be well demonstrated on scrotal ultrasonography if the clinical examination is equivocal.  Typically, no treatment is required.

If there is uncertainty as to whether testicular pain is related to a cyst, it is possible remove the fluid through a tiny needle (this is done in the clinic). If the pain is unchanged the cyst is unlikely to be the culprit.

If the cyst is in a sensitive location or it has grown to the point where it is interfering with daily life, the pain may be present until the cyst is removed.  Surgery would then be an option.

In general, fertility should not be affected to any significant degree if the other testicle is functioning normally.  However some urologists avoid surgery until a man is certain he has finished his family as there is always a risk of scar formation in the area of the tubules causing a blockage to the flow of sperm on that side.  Discuss this issue with your personal urologist.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

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