Epididymal cysts in children: a systematic review and meta-analysis of treatment approaches and clinical outcomes

To systematically synthesise current evidence on the epidemiology, clinical characteristics, natural history, and outcomes reported under different management approaches for epididymal cysts (ECs) in boys.

A PRISMA 2020-compliant systematic review was conducted using PubMed, Embase, and Scopus from inception through 31 August 2026. Observational studies including males younger than 18 years with ECs and reporting clinical outcomes were eligible. Random-effects meta-analyses of single-arm proportions were performed for key prevalence outcomes.

Nine retrospective studies published between 2002 and 2025 were included, comprising 492 paediatric patients. No controlled comparative studies were identified. ECs were most frequently detected incidentally or during evaluation for painless scrotal swelling. Lesions were predominantly unilateral (79-90%), most were located in the epididymal head, and reported cyst size ranged from 2 to 40 mm. Associated conditions included hydrocele, varicocele, and testicular microlithiasis, with no reported link to malignancy. Conservative management was the preferred initial strategy in contemporary cohorts, whereas earlier series reported higher surgical rates. Surgery was mainly indicated for persistent pain or progressive enlargement and involved open excision, with high rates of symptom resolution and low reported morbidity. Meta-analysis showed that bilateral cysts occurred in 8% (95% CI 7-9%; I2 = 12.5%) of patients, complete spontaneous regression occurred in 12.2% (95% CI 8.3-16.1%; I2 = 88.1%), and 7.4% (95% CI 3.1-11.7%; I2 = 94.7%) of children required surgery. Postoperative complications were uncommon (3.4%; 95% CI 1.1-5.6%; I2 = 0%), and reported torsion events were rare (1.6%; 95% CI 0.7-2.5%; I2 = 0%); the available data did not establish that ECs predispose to testicular torsion.