Spermatocele

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at June 22, 2016
StartDiseasesSpermatocele

A spermatocele is a cyst that contains fluid and sperm and is usually located in the epididymis. The term spermatocele is used interchangeably with epididymal cysts though technically epididymal cysts do not contain sperm whereas spermatoceles usually do. The sperm cells are dead. Another term that is used to describe spermatoceles is spermatic cysts.

Contents

Definition & Facts

The epididymis is a tube located behind the testicles which connects the testicle to the vas deferens which then carries sperm to seminal vesicles and prostate before exiting through the urethra for ejaculation. Spermatoceles are a type of benign scrotal mass that forms on the epididymus.

Other types of scrotal masses include hydroceles which are cysts on the testicles, inguinal hernias which is where part of the abdominal wall pushes out through the groin, and varicocele where the veins of the scrotum become enlarged. These conditions must be ruled out before a diagnosis of spermatoceles can be obtained. Spermatoceles do not cause cancer, male infertility, or erectile dysfunction.

Symptoms & Complaints

Spermatoceles are usually painless. However, some patients may complain of pain and some form of discomfort in the testicle if the spermatoceles reach a certain size. The lumps can be felt on the top of the testicle and are discovered during a testicular self-examination, and they tend to be less than 1 centimeter in length. Spermatoceles larger than 5 centimeters may be candidates for surgical treatment. Spermatoceles feel smooth to the touch and contain milky fluid.

Spermatoceles may cause psychological stress for a patient who has not yet received a diagnosis and is concerned that the mass may be cancer. Upon close examination with light, spermatoceles pass light because they are not solid and not cancerous.

Causes

It is unclear what causes spermatoceles. Spermatoceles may result from injury, swelling, or scarring of the tissue of the epididymus. They may also be caused by a blockage in the tubules that connect the testicle to the epididymus. The ambiguity over how and why they form makes preventing them difficult.

Diagnosis & Tests

Spermatoceles will need to be distinguished from other benign scrotal masses which can be accomplished through noting differences in symptoms. Hematoceles result from injury and involves the scrotum filling up with blood; this will be very painful. Varicoceles may create a feeling of heaviness in the scrotum, whereas hydroceles may cause pain in the lower back and pain in the stomach. Inguinal hernias typically present symptoms when the individual bends over or lifts heavy objects.

Testicular self-examinations and physical examinations performed by a doctor are two common ways in which spermatoceles are discovered. The doctor will feel the testicle for a solid growth. An ultrasound helps the doctor make a diagnosis that the mass is a cyst rather than something more serious.

Treatment & Therapy

Treatment of spermatoceles is focused on relieving symptoms. If spermatoceles are asymptomatic, then treatment will not be opted for. The patient would need to have frequent and routine check-ups so as to keep an eye on the development of the cystic cells. For patients who have spermatoceles that are so large (5 centimeters or more) that they are causing pain and discomfort, they may opt for a surgery called a spermatocelectomy or a procedure called sclerotherapy.

Sclerotherapy involves puncturing the cyst, draining the cyst of fluid through a syringe, and injecting the cyst with a sclerosing agent. Local anesthesia will typically be administered. Ultrasound may be used to guide the surgeons particularly if there are multiple spermatoceles in the scrotum. Narcotic painkillers may not be necessary for patients who have completed surgery. Sclerotherapy carries the risk of infertility and epididymitis which is a painful condition in which the epididymus becomes inflamed often due to a bacterial infection.

Spermatocelectomy is a surgical procedure to remove the spermatoceles. It can present high risks of injury to the epididymus and to the blood flow of the testicle. Infertility is a complication of this surgery. Spermatocelectomy involves either removing part of the serous membrane that covers the testicle (the tunica vaginalis) or leaving it intact.

In the former case, the spermatocele will be separated from the epididymus with the surgeons locating its connection point and tying it. The spermatocele will be dissected and removed and all incision points stitched up. Patients recovering from spermatocelectomy typically require narcotic painkillers such as Vicodin® which is a combination of hydrocodon and acetominophen (Tylenol®).

There is controversy about which procedure is more effective: sclerotherapy vs. spermatocelectomy. Sclerotherapy may be a preferable alternative to spermatocelectomy because of the lower risk of complications and the absence of general anesthesia, though other studies show that sclerotherapy may be less effective than surgery and also pose risky complications all the same. Studies have shown that percutaneous sclerotherapy, if performed twice, had a success rate of 84% in curing spermatoceles. Studies have also shown that spermatocelectomy are effective 94% in curing pain associated with spermatoceles.

Prevention & Prophylaxis

Testicular self-examinations are crucial to detect spermatoceles, but there is no way to conclusively prevent them. Testicular self-examinations involve holding the penis out of the way and checking each testicle one by one. The next step is to hold the testicle in both hands between the thumb and fingers and roll the testicle between the fingers and thumbs, noting any lumps or abnormalities in the scrotum. The texture, the consistency, the size, and the shape of the testicles should all be observed.

It is recommended that men perform testicular self-examinations every month and establishing an awareness of one's anatomy will help a man detect any irregularities. While spermatoceles are benign and are mostly a nuisance, they may raise false alarms about more serious conditions such as testicular cancer. Familiarizing oneself with one's body helps fend off any unnecessary concerns while also empowering the individual to notice abnormalities and seek immediate diagnosis and treatment.