A cyst is a swelling that contains fluid, semisolid material or gaseous material. Cysts are very common all over the body, and most do not become cancerous. Testicular cysts are often caused by fluid collection secondary to lymphatic channel blockage, infection or engorgement of the testicular veins.
If you ever find a testicular (or scrotal) lump or a cystic mass near the testis, it needs to be examined by a doctor even if it is painless and does not cause symptoms.
Some cysts may go away with rest and scrotal support, whereas others may need surgical intervention. Most testicular cysts do not cause significant discomfort and may only be monitored for progress.
The testicular cysts or cystic swelling of the scrotum, which may resolve spontaneously or go away with rest and scrotal support, include:
- Small hydrocoele: A small hydrocoele (a collection of fluid between the tunica vaginalis, the visceral and parietal layers of the testis) will often resolve without surgical intervention.
- Acute idiopathic scrotal edema: This may present as a unilateral or, more commonly, bilateral swelling of the scrotum along with redness and warmth. The swelling is not tender and may extend to the penis or perineum (area between scrotum and anus). This self-limiting condition is often seen in boys younger than 10 years old.
- Varicocele: This is an abnormal dilatation of veins within the pampiniform plexus (network of veins that drain the testis and epididymis) that may result in cystic swelling. Small varicoceles often get better with rest and scrotal support. However, larger ones may need surgical intervention.
- Epididymo-orchitis: This is an inflammation of the epididymis (the tube-like structure that stores and carries sperm), which lies alongside the testis. It may be due to associated urinary tract infections or UTIs, though rarely is it due to a sexually transmitted disease or STD. Treating the associated condition relieves the cystic swelling unless there is pus formation.
- Scrotal hematoma: Trauma (scrotal hematoma) to the testis may sometimes result in a cystic testicular swelling or a hematoma formation. This will go away in time with rest and fomentation. Surgical intervention may be needed in severe cases.
- Hydrocele: Cystic swelling of the scrotum caused by an abnormal collection (or abnormal reabsorption) of the fluid in the tunica vaginalis. Sometimes, it may be secondary to trauma, inflammation or tumors. Small hydroceles may go away on their own, larger ones need surgical interventions.
The following testicular cysts may need intervention because they will not go away on their own:
- Testicular tumors: Most testicular tumors are solid, but they may rarely present as cystic swelling. The risk factors for testicular tumors are cryptorchidism (undescended testis), family history of testicular cancer and a history of testicular tumor in the contralateral testis.
- Epididymal cysts: The most common noncancerous cysts outside the testis, they are present in the epididymis (a coiled, tube-like structure that stores and transports sperms). Epididymal cysts are present as smooth, painless lumps above and behind the testes. Most cysts require no treatment. The patient just needs counseling. Occasionally, epididymal cysts may cause pain in the scrotum, requiring removal.
- Cystic hygroma: Cystic swelling seen due to blockage of the lymphatic system. It may be seen at birth. Most hygromas need extensive treatment and surgical removal.
- Sebaceous cysts: These are mobile, firm, smooth swellings within the skin of the scrotum. Though generally painless, they may get infected and result in pain. They may also result in multiple cysts.
- Testicular torsion: The torsion or twisting of the testis is a painful condition that may need urgent intervention because there is a risk of testicular gangrene if untreated. It may be present as testicular swelling that may feel cystic due to the surrounding soft tissue edema.
How are testicular cysts diagnosed?
Most testicular cysts are not palpable on self-examination. Therefore, regular follow-ups with a doctor are important for swift diagnosis and prompt treatment.
Most swellings of the testis are diagnosed by ultrasonography and color doppler. If the radiologist cannot make a diagnosis with a testicular doppler, a contrast-enhanced ultrasound (CEUS) or a testicular magnetic resonance imaging (MRI) may be performed.
How are testicular cysts managed?
Most testicular cysts require only counseling and monitoring since they do not turn malignant or cause complications. Smaller cystic swellings can be managed with rest and scrotal support. Infected cysts may require antibiotics and NSAIDs. Surgical intervention often remains the last resort for the cysts if they enlarge, cause pressure on surrounding organs or undergo a malignant change.
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Vissamsetti B, O’Flynn KJ, Pearce I. Diagnosis and Treatment of Benign Scrotal Swellings. Trends in urology & men’s health. https://wchh.onlinelibrary.wiley.com/doi/pdf/10.1002/tre.200
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