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Spermatocele: Causes, Symptoms and Treatment

Definition

Spermatoceles are cysts of the epididymis, which arise from the epididymal duct and contain sperm.

Epidemiology of Spermatoceles

The prevalence in ultrasound screening studies is 10%. The prevalence of spermatoceles increases with age (up to 30%).

Signs and Symptoms

• Painless testicular swelling
• Positive transillumination
• Seldom: disturbing size or pain

Diagnosis of Spermatoceles

Ultrasound imaging:

Testicular ultrasound imaging is used for the differential diagnosis of scrotal swelling. Spermatoceles present with an anechoic cystic mass in contact with the epididymis. Tubular ectasia of the rete testis (TERT) is associated with spermatocele.

Testicular ultrasound imaging: spermatocele with tubular ectasia of the rete testis.

Treatment of Spermatoceles

Indication for surgery:

Disturbing size or pain.

Contraindications for surgery:

Patients with desire for children: Spermatocelectomy causes (with a high probability) sterility on the operated side. Delayed repair or cryopreservation of sperm is recommended if fertility is an issue.

Surgical technique of spermatocelectomy

The testis is delivered through a scrotal incision. Resect the spermatocele with careful dissection between the spermatocele and epididymis. The ligation of the final attachments of the spermatocele prevents granuloma formation. The operation is finished with the closure of the tunica vaginalis, tunica dartos (subcutaneous suture), and scrotal skin. Please see section spermatocelectomy for details. Epididymectomy is performed if multiple cysts are present.

Puncture of the Spermatocele with Sclerotherapy

Sclerotherapy of spermatoceles is not a standard therapy and has been tested only in small studies.

References

Rubenstein u.a. 2004 RUBENSTEIN, R. A. ; DOGRA, V. S. ; SEFTEL, A. D. ; RESNICK, M. I.: Benign intrascrotal lesions.
In: J Urol
171 (2004), Nr. 5, S. 1765–72

  Deutsche Version: Spermatozele: Ursachen und Therapie