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Spermatoceles

Sperm is created in the testicles and then transported through a complex genital duct system to the penis and out through the urethra.

Every component of this system is important for ideal sperm production and ejaculation. At times, there are several abnormalities that affect the ideal functioning of this system. Scrotal masses are the most common abnormalities noticed in the genital duct system. Although some of these abnormal masses are benign and pose no threat others are known to be dangerous and need immediate diagnosis and proper treatment on time.

Spermatoceles are benign and generally painless masses that grow at the top of the testicle. Thus, it is important for a patient to seek prompt medical attention when he identifies a scrotal mass or abnormality while performing testicular self examination. The following information will assist you when talking to a urologist about spermatoceles. 


What is a spermatoceles?

Spermatocele, also known as a spermatic cyst, are typically painless, noncancerous (benign) cysts that grow from the epididymis near the top of the testicle. Spermatoceles are typically smooth and they are usually filled with a milky or clear colored fluid containing sperm. Over time, spermatoceles may remain stable in size or they may grow. If in fact the size becomes bothersome, or results in pain, then there are several treatment options to rectify the problem.


What can cause spermatoceles?

The precise cause of spermatoceles is not known. While spermatoceles may form as a result of trauma or inflammation, these conditions are certainly not required for spermatocele formation.

Others suggest that blockage of the efferent ducts and epididymis result in spermatocele formation. Additionally, in utero exposure to diethylstilbestrol (DES), a synthetic form of estrogen, has also been suggested as a possible cause. 


What are the symptoms of spermatoceles?

Men with spermatoceles usually have no symptoms. However, when associated symptoms are present, they may include scrotal heaviness and/or pain. 


How are spermatoceles diagnosed?

  • Spermatoceles are typically discovered through a man's self-examination of his testicles or at the time of an evaluation by a physician.

  • Light can be shined through a spermatocele (transillumination), indicating that the mass is not a solid tumor but more likely a benign cyst.

  • Ultrasound examination remains a very reliable means of evaluation and is a relatively quick, noninvasive and inexpensive test.

  • Other diagnostic imaging tests are not generally used although magnetic resonance imaging (MRI) can also be used as an adjunct in cases where scrotal ultrasound is inconclusive. 


How are spermatoceles treated?

Since spermatoceles generally do not cause discomfort and often go unnoticed by patients, they rarely require treatment. Nevertheless, some affected individuals do experience significant associated symptoms, such as bothersome size or pain. In such cases, the available treatment options include:

Medical therapy: Oral analgesics or anti-inflammatory agents may be used to relieve pain associated with symptomatic spermatoceles.

Surgical therapy: Spermatocelectomy involves surgical removal of the spermatocele from the adjoining epididymal tissue. The overall goal of surgical therapy is removal of the spermatocele with preservation of the continuity of the male reproductive tract. 

Other therapies: Aspiration and sclerotherapy are two less commonly utilized approaches to treat spermatoceles. Aspiration involves puncture of the spermatocele with a needle and withdrawal of its contents into a syringe. Sclerotherapy is performed with subsequent injection of an irritating agent directly into the spermatocele sac to cause it to heal or scar closed, removing the spermatocele space and decreasing the odds of fluid reaccumulation. Although several reports describe the effectiveness and tolerability of these treatment options, they are generally not recommended.


What can be expected after surgical treatment?

Spermatocelectomy is typically performed as an outpatient procedure, under a variety of possible anesthetic agents.


Potential complications of spermatocelectomy include:

  • Fever

  • Infection

  • Bleeding (scrotal hematoma)

  • Persistent pain.

  • Sub-fertility or infertility.


Frequently asked questions: 

Do spermatoceles lead to testicular cancer?

Spermatoceles are benign epididymal lesions. They are separate and distinct from the testicle. Patients with spermatoceles do not have an identified increased risk of testicular cancer. 


Are any medications available to cure my spermatocele or prevent the formation of additional ones?

Medications are available to treat associated discomfort or pain, but no medication will lead to resolution or prevention of spermatoceles.

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