Spermatocelectomy
A spermatocelectomy removes a spermatocele, a fluid-filled cyst that grows from the epididymis just above and behind the testicle.
Also called Spermatocele removal, Spermatocele excision, Spermatocele surgery, Epididymal cyst removal, Epididymal cyst excision, Cyst on my testicle, Lump above the testicle, Sperm cyst
- Where
- Outpatient surgery center or hospital operating room
- Anesthesia
- General or spinal anesthesia; sometimes local numbing with sedation
- Time in the room
- 45 minutes to 1 hour
- Hospital stay
- Same day
- Back to normal
- 1 to 2 weeks; swelling settles over several weeks
- Back to work
- Desk work in 3 to 5 days; heavy physical work after 2 to 3 weeks
Overview
A spermatocele is a smooth, fluid-filled cyst that grows from the epididymis, the coiled tube on the top and back of the testicle where sperm mature. The fluid often contains sperm, which is where the name comes from. Spermatoceles are very common and are often found by chance. They can be as small as a pea or grow larger than the testicle, and some men describe the feeling as having a third testicle.
Spermatoceles are not cancer and do not turn into cancer. An ultrasound confirms that the lump is a cyst sitting outside the testicle, not a growth inside it. Most need no treatment. Surgery is offered when a spermatocele is large, growing, uncomfortable, or bothersome to look at.
In a spermatocelectomy, your surgeon makes a small cut in the scrotum, separates the cyst from the epididymis, ties off its narrow stalk, and removes it. Many surgeons use magnifying glasses or a microscope to protect the epididymis.
There is one trade-off to weigh. Because the cyst grows from the sperm-carrying tubes, removing it can block sperm flow on that side. For men who may want children in the future, it is often wise to wait if the cyst is not causing real trouble, or to discuss the approach carefully with your surgeon.
The parts of your body involved
Sperm made in the testicle leave through a set of tiny tubes into the head of the epididymis, at the top of the testicle. They mature as they pass down the epididymis to its tail and then enter the vas deferens. A spermatocele forms when one of the tiny tubes near the head of the epididymis swells into a cyst. Because it hangs off the epididymis rather than the testicle, it can be felt as a separate, smooth ball above the testicle. A thin sac called the tunica vaginalis surrounds both.
- Testicle
Makes sperm and testosterone. It is normal in men with a spermatocele.
- Epididymis
The coiled tube on the top and back of the testicle where sperm mature. The cyst grows from its upper part, the head.
- Tiny outflow tubes
Small channels carrying sperm from the testicle into the epididymis. A spermatocele usually starts in one of these.
- Vas deferens
The tube that carries sperm onward from the epididymis.
- Tunica vaginalis
The thin sac around the testicle and epididymis.
Why it’s done
Most spermatoceles are left alone. Surgery is considered when the cyst affects comfort or daily life.
- Size
A large cyst can feel heavy and drag on the scrotum.
- Pain or aching
Some men have a dull ache, especially after standing, exercise or sex.
- Growth
A cyst that keeps getting bigger on repeat exams or ultrasound.
- Daily activities
Trouble with clothing, sitting, sports or sex.
- Appearance or worry
Some men are bothered by the lump even after being reassured that it is harmless.
Other options
- Watching
A spermatocele is harmless. If it does not bother you, it can be left alone and rechecked if it changes.
- Support and pain relief
Snug underwear and anti-inflammatory medicine help many men with mild aching.
- Needle drainage
Fluid can be drawn off with a needle, but the cyst usually refills, and each needle carries a small risk of infection or bleeding.
- Drainage with sclerotherapy
After draining, a medicine is injected to scar the cyst shut. It can work, but the scarring can block the epididymis, so it is usually avoided in men who may want children.
Getting ready
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Weeks before
The week before
The day before
The morning of surgery
In the operating room, step by step
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1. Going to sleep
You lie on your back on the operating table. The anesthesia team puts you to sleep or numbs you from the waist down. The scrotum is cleaned and draped.
After the operation
Right afterward
- Recovery room
You wake up with a snug dressing and support. The scrotum feels sore and full.
- Ice
Ice packs are often started in recovery.
- Passing urine
The team checks that you can pass urine before you leave, especially after spinal anesthesia.
- Going home
Most men go home 1 to 3 hours after surgery with a driver and written instructions.
At home
- Pain
Soreness is worst for the first 2 to 3 days. Acetaminophen and, when allowed, ibuprofen usually control it.
- Ice and support
Ice on and off for 48 hours. Wear snug support day and night for 1 to 2 weeks.
- Swelling
Some swelling is expected for 2 to 4 weeks. Lying back with the scrotum raised on a folded towel helps.
- The wound
A little oozing is normal for a day or two. Stitches dissolve on their own over 1 to 3 weeks.
- Showering
Usually after 24 to 48 hours. No baths, hot tubs or swimming for 2 weeks.
- Activity
Walk from the first day. Avoid running, cycling and sports for about 2 weeks.
- Lifting
Avoid lifting more than about 20 pounds for 2 to 3 weeks.
- Sex
Usually after about 2 weeks, once comfortable.
- Driving
Once you are off strong pain medicine and can brake comfortably, usually after a few days.
- Work
Desk work in 3 to 5 days. Physical work after 2 to 3 weeks.
Recovery timeline
- Day 0Home the same day
You go home a few hours after surgery with a dressing and support.
- Days 1 to 3Peak soreness
Swelling and aching are at their worst. Rest, ice and pain medicine help.
- Week 1Up and about
Most men return to desk work. Bruising may spread and change color.
- Weeks 2 to 3Back to activity
Exercise, lifting and sex are usually back to normal.
- Weeks 4 to 6Swelling settles
Most of the swelling is gone. A small firm spot where the cyst was may still be felt.
- Months 2 to 3Final result
The scrotum is close to its final size and feel.
- Long termCheck new lumps
Most cysts do not return. Keep checking your testicles monthly and report any new lump.
What it feels like
Finding a lump in the scrotum is frightening, and much of the emotional weight comes before surgery. The recovery itself is usually short.
Finding the lump
Most men fear cancer when they first feel a lump.
What helpsA prompt visit and ultrasound usually settle the question quickly. Spermatoceles sit outside the testicle and are harmless.
Deciding on surgery
Some men are torn between living with a harmless lump and having surgery near the sperm tubes.
What helpsAsk your surgeon how likely surgery is to affect fertility on that side, and how much that matters given your plans.
Waking up
The scrotum feels sore and tight under the dressing.
What helpsIce and pain medicine on a schedule for the first day.
The first few days
Swelling and bruising can look worse than expected, and walking feels awkward.
What helpsKeep the support on and rest with the scrotum raised. Call if one side becomes tense and keeps growing.
A few weeks later
Most men are relieved that the lump is gone, though a firm spot from healing may remain for a while.
What helpsGive it 2 to 3 months to settle, and mention anything new at your follow-up visit.
How well it works
Success means the cyst is gone and the scrotum feels normal once healing is complete.
- Lasting result
Most cysts do not come back after the whole cyst is removed, though some do.
- When to judge
Swelling from surgery can hide the result for several weeks. The final feel is clear by 2 to 3 months.
- Lab results
The cyst is examined in the lab. This is routine and the result is almost always a simple cyst.
- Follow-up
Usually one visit 2 to 6 weeks after surgery.
Risks
Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.
Common
Swelling of the scrotum for several weeks is common and settles on its own.
Purple bruising that fades over 2 to 3 weeks.
Aching for several days, controlled with simple pain medicine and ice.
Less common
Surgery on the epididymis can scar it and block sperm flow from that testicle. For most men with a normal other side, this does not prevent fathering children, but it matters if the other side is not normal.
A collection of blood can make the scrotum tense and painful. Most settle with rest and support; some need draining.
Redness, warmth, drainage or fever, usually treated with antibiotics.
A new cyst or a fluid collection around the testicle can form and may need treatment.
Rare
Ongoing pain after healing is rare.
Damage to the vessels can cause the testicle to shrink. This is rare.
Call your care team or go to the emergency room if
- Fever of 101°F (38.3°C) or higher, or shaking chills
- Swelling that gets rapidly larger, tense and very painful over a few hours
- Bleeding that soaks through the dressing and does not stop after 10 minutes of firm pressure
- Redness spreading across the scrotum, pus, or a bad smell from the wound
- Pain that keeps getting worse, or is not controlled by your medicine
- You cannot pass urine for 8 hours after surgery
Questions to ask your surgeon
- Has the ultrasound confirmed this is a cyst outside the testicle?
- Is it large enough or bothersome enough that surgery makes sense now?
- How might surgery affect my fertility on this side?
- Should I wait until I am done having children?
- Do you use magnification to protect the epididymis?
- How often do the cysts you remove come back?
- How long will the swelling last?
- How long should I avoid lifting, exercise and sex?
- When can I return to work?
Words you may hear
- Spermatocele
- A fluid-filled cyst growing from the epididymis that often contains sperm.
- Epididymal cyst
- A cyst of the epididymis. Spermatoceles are a type of epididymal cyst.
- Spermatocelectomy
- Surgery to remove a spermatocele.
- Epididymis
- The coiled tube on the top and back of the testicle where sperm mature.
- Vas deferens
- The tube that carries sperm away from the epididymis.
- Tunica vaginalis
- The thin sac around the testicle.
- Hematoma
- A collection of blood under the skin causing swelling and bruising.
- Sclerotherapy
- Injecting a medicine into a drained cyst so its walls scar together.
- Scrotal ultrasound
- A painless scan with sound waves that shows the testicle and nearby structures.
Common questions
Is a spermatocele cancer?
No. It is a harmless cyst outside the testicle and does not turn into cancer. Testicular cancer grows inside the testicle itself, which is why the ultrasound is so useful.
Does it need to come out if it is small?
Usually not. Most spermatoceles are left alone unless they cause discomfort, grow, or bother you.
Will surgery affect my fertility?
It can block sperm flow on that side. Most men with a normal testicle and epididymis on the other side can still father children, but if you plan to, discuss timing with your surgeon.
Why not just drain it?
The cyst usually refills after draining. Injecting medicine to scar it can block the epididymis, so it is generally avoided in men who may want children.
Can it come back?
It can, but most do not after the whole cyst is removed.
Is a spermatocele caused by something I did?
No. The cause is usually unknown. They are common, especially in middle age, and some appear after a vasectomy or an injury.
Sources this page draws on
- MedlinePlus (U.S. National Library of Medicine), Spermatocele
- MedlinePlus (U.S. National Library of Medicine), Scrotal masses
- European Association of Urology, EAU Guidelines on Sexual and Reproductive Health
- American Urological Association and American Society for Reproductive Medicine, Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline (2020)
Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.