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Epididymal Cyst Removal

What is it?

An epididymal cyst is a swelling containing watery liquid lying just above the testicle. There may be more than one cyst present and they can occur above both testicles. They are quite harmless.

The Operation

You will have a general anaesthetic, and will be asleep for the whole operation. A cut is made into the skin over the cyst. The cyst is removed and the cut is stitched up. The cyst and the fluid will be examined in the laboratory. Your operation may be done as a day case. This means that you come into hospital on the day of the operation and go home the same day.

Any Alternatives

If you leave things as they are, the cyst will most probably over time get bigger. Sometimes this takes years. You can afford to wait and see if you wish. The fluid from the cyst can be drawn out using a needle, but the fluid will build up again in a month or two. There is no injection treatment that works well.

Before the operation

Stop smoking and get your weight down if you are overweight. (See Healthy Living). If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. Check you have a relative or friend who can come with you to the hospital, take you home, and look after you for the first week after the operation. Sort out any tablets, medicines, inhalers that you are using. Keep them in their original boxes and packets. Bring them to the hospital with you.

On the ward, you may be checked for past illnesses and may have special tests to make sure that you are well prepared and that you can have the operation as safely as possible. . Please tell the doctors and nurses of any allergies to tablets, medicines or dressings. You will have the operation explained to you and will be asked to fill in an operation consent form. Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks.

After - In Hospital

Most patients have local anaesthetic injected into the wound, even if they have a general anaesthetic for the operation. This is done to try and reduce the pain that you may experience after the operation. Usually the wound is almost pain-free. There may be some discomfort on moving. Simple painkillers should easily control this discomfort. If not, painkilling injections can be given. Ask for more if the pain is not well controlled or if it gets uncomfortable. . A general anaesthetic will make you slow, clumsy and forgetful for about 24 hours. The nurses will help you with everything you need until you are able to do things for yourself. Do not make important decisions, drive a car, use machinery, or even boil a kettle during that time.

Some hospitals arrange a check-up about one month after you leave the hospital. By that time the results of the examination of the cyst and the fluid should be available. Others leave check-ups to the general practitioner. The nurses will advise about sick notes, certificates etc.

After - At Home

After two to three hours on the ward, you should feel fit enough to go home. Make sure you are going home by car with your relative or friend. once home, go to bed. Take painkiller tablets (such as paracetamol) every six hours to control any pain. The next morning you should be able to get out of bed quite easily despite some discomfort. You will not do the wound any harm. The exercise is good for you.

The second day after the operation, you should be able to spend most of your time out of bed in reasonable comfort. You should be able to walk 50 yards slowly. By the end of a week the wound should be nearly pain-free. It is important that you pass urine and empty your bladder within 6 to 12 hours of the operation. If you have difficulty doing that , phone the hospital ward or your GP. The wound has a dressing which may show some staining with old blood in the first 24 hours. Replace the dressing if it gets dirty. You can take the dressing off after 48 hours. There is no need for a dressing after this unless the wound is painful when rubbed by clothing. The stitches in the skin will usually slip out after about 7 to 10 days.

There may be some purple bruising around the wound which spreads downwards by gravity and fades to a yellow colour after two or three days. This is expected and you should not worry about it. . There may be some swelling of the surrounding skin which also improves in two to three days. After 7 to 10 days, slight crusts on the wound will fall off. Occasionally minor match-head sized blebs (blisters) form on the wound line, but these settle down after discharging a blob of yellow fluid for a day or so. You can wash as soon as the dressing has been removed but try to keep the wound area dry for a week. Soap and tap water are entirely adequate. Salted water is not necessary.

You are likely to feel tired for one to two days. After one to two weeks you should be able to return completely to your usual level of activity. After about two to three days you can lift as much as you used to lift before the operation. You can drive as soon as you can make an emergency stop without discomfort in the wound i.e. after about two days. You can restart sexual relations within a week or so. You should be able to return to a light job within three to four days and a heavy job within six to seven days.

Possible Complications

As with any operation under general anaesthetic there is a very small risk of complications related to your heart or you lungs. The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will bring the risk for such complications very close to zero.

Complications are rare and seldom serious. Bruising and swelling may be troublesome, particularly if the cyst is large. The swelling may take four to six weeks to settle down. Putting on a scrotum support (special type of underwear that elevates the scrotum) lessens the chances of getting swelling or, if you do get swelling, can help to make you more comfortable. Infection is a rare problem and settles down with antibiotics in a week or two. The area on top of the testis where the cyst used to be might feel thickened. This will gradually get better but there is a good chance that it will not disappear completely. This is expected and you should not worry about it. In addition, after the operation the testis on the side of the operation might end up a little higher compared to before the operation. This is also something that you should not worry about. Aches and twinges may be felt in the wound for up to six months. Occasionally there are numb patches in the skin around the wound which get better after two to three months. Recurrence of the cysts happen in about 5 in 100 cases.

Very rarely this operation can affect your fertility (your ability to make a woman pregnant). This happens because the structures that carry the sperm from the testis can be damaged during the operation. If fertility is still important to you, discuss the possibility of this complication with your surgeon.

General Advice

The operation is a relatively minor one but can be irritatingly slow to become pain-free if there has been swelling after the operation. We hope these notes will help you through your operation. They are a general guide. They do not cover everything. Also, all hospitals and surgeons vary a little. If you have any queries or problems, please ask the doctors or nurses.

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