Does removal of Epididymal cysts cause damage to epididymis?

Posted on Wed, 14 Oct 2015 in Urinary and Bladder Problems
Question: Epdidymal cysts left testicle - your advice please Dear Urologist Doctor, If possible, am looking for some advice specific to 2 epdidymal cysts that I have on my left testicle. They are both located in the head (top) of the epididymis. They are each about 8cm in size. Below is the link of the UItrasounds of the testicle Below is the link of the Ultrasounds report - report says left testicle appears normal apart from 2 epdidymal cysts. There is no varicocoele or hydrocoele I first noticed pain in my left testicle in March 2014. When leaning forward while sitting on a chair I felt pain, as the weight of my upper body put pressure on the testicle. In July 2014 there was trauma to the testicle that caused severe pain. It took 4 months for the pain to completely go away. In July 2105, again there was trauma to the testicle that cause severe pain. A mild pain is still present. I am considering having surgery to remove the cysts. The pain is coming from the head of epididymis where the cysts are located. There is not much inflammation or swelling. I can complete daily activities. But I would like to exercise more, but the pain in the testicle prevents me from even low intensity exercise. I have pain when lifting my one year old son for longer than a minute or two, making fast sideways movements, sitting normally on a chair (i have to lean to one side or find a comfortable chair). These are the actions I am doing to help recovery and reduce pain: -taking aspirin 600mg 4 times per day (2400mg per day). Taking Ibuprofen 400mg 4 times per day (1600mg per day). I do 1 week of aspirin, then swap to 1 week of Ibuprofen. I have found that swapping helps to increase the effectiveness of the aspirin and ibuprofen. note that I also took antibiotics for the first few weeks each in July 2014 and July 2015. -icing of the testicle -improving blood circulation to the testicle - walking daily, groin stretches - pelvic floor muscles relief: 1)massage: lower back, buttocks - side and back, lower abdomen - front, side. 2) not intentionally flexing pelvic floor muscles when urinating / ejaculating -warm bath -few days (2-4days) between sex. ie sex, then no sex for 2-4 days. -no alcohol I have some questions to ask. I'm wondering if you might please advise: -do you believe the cause of the pain is the cysts? -will the removal of the cysts relieve the pain associated with sitting and exercising? - will the cysts of this size and located at the head of the epididymis (please see Ultrasounds) be able to be removed without damaging the epididymis? Will removal of the top part of the epididymis be necessary? -if the top part the epididymis is removed, will sperm still be produced inside the testicle and able to transfer to the penis (fertility)? Does the sperm get clogged/blocked testicle? how is fertility affected? - given the location of the cysts, is it likely that the internal structures will not be damaged and that I will remain fertile? -A few months after surgery to remove the cysts, if there is still pain, what could be done to get rid of the pain? -if there is hydrocoele found will this also be removed during surgery? -is the surgery a general anaesthesia? -would you agree that it is better to have the cysts removed sooner? Because if they grow larger, it may be more likely to remove part of the epididymis during the removal of the cysts? -after surgery, will there be pain during intercourse over the long term? If part or whole of the epididymis is removed, will there be pain during ejaculation? - will I need to use a catheter after surgery? If yes, how long will I need to use it? Will there be pain to urinate? -My wife and I may decide to have children in the future. I am 40 years old and I am presently fertile - we have a son. Before surgery I plan to go to the fertility clinic to have my sperm cryofreeze stored. After surgery I plan to have a fertility test to see if I am still able to have children the natural way. Would you agree with this approach to ensure that I am able to have children in the future? -Would you agree with these figures stated by the The British Association of Urological Surgeons? The British Association of Urological Surgeons indicates that post surgery, there is less than 1 in 50 chance of scarring of the epididymis causing impaired fertility. And that post surgery, there is less than 1 in 50 chance of chronic pain in the testicle or scrotum. Below is the link - I am very grateful for any answers and advice that may be given. Sincerely, XXXXX
Answered by Dr. Matthew J. Mangat 3 hours later
Brief Answer:
Epididymal cysts removal is a minor operation.

Detailed Answer:
Hello XXXXXXX and welcome to HCM.
As an Urologist, i can understand your concern.
I'm impressed with your references to the BAUS article, which have already answered some of your doubts.!!
What you should know is, you've two testis. The right one is normal.
Hence your fertility status will be normal, even if left testis is removed.!!
Surgery of epididymal cysts, doesn't remove epididymis.
Only cysts are removed, without damage to epididymis.
So, don't worry too much about it, because it doesn't affect sexual health anyway.
About indication for removal, it depends on your symptoms related to it only.
No questions of sperms being stored in testis either. So forget storing sperms.
Cysts increase very gradually, and removal is usually done under local anesthesia.
Ensure you get it done by a qualified Urologist. It's a day case surgery.
Again, no question of catheter.
Hope your doubts are cleared.
Wish you well.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Matthew J. Mangat 8 days later
Dr. XXXXXXX J. Mangat,

Im sorry the 2 cysts size are 8mm each. does this alter your advice?

additional information:

-often i feel pain shooting up from my left side upper groin to lower abdomen

-masturbating on hands and knees is significantly less painful afterwards than when lying on back

Answered by Dr. Matthew J. Mangat 20 minutes later
Brief Answer:
Pain is due to the cysts. Posture and masturbation, unrelated.

Detailed Answer:
1. No change in advice, even with two cysts being 8mm in size.
2. Pain should related to the epididymal cysts on left side. If bothersome, you can take an analgesic like tablet Chymoral Forte, twice daily.
3. Posture alteration during masturbation, shouldn't be given much consideration.
Hope you're doubts are cleared.
Get well soon.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Answered by
Dr. Matthew J. Mangat


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