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Spermatocelectomy: Surgery for Spermatoceles

Indication for a Spermatocelectomy

Symptomatic spermatoceles: large size or pain.

**Spermatocelectomy:** findings after the scrotal approach.
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Contraindications to Spermatocelectomy

Coagulation disorders, local skin infections, significant comorbidity with an increased risk for surgery. Operations of the epididymis usually lead to the closure of the epididymal duct. Spermatocelectomy should not be performed, if fertility is an issue.

Preoperative Patient Preparation

Patient positioning: supine position
General, spinal, or local anesthesia
Perioperative antibiotic prophylaxis

Spermatocelectomy: Surgical Technique

**Schematic illustration of spermatocelectomy:** incision of the tunica vaginalis visceralis over the spermatocele, mobilization of the spermatocele and ligation of the base, closure of the tunica vaginalis visceralis.

Approach the testis with a scrotal incision.
Incise the visceral tunica vaginalis covering the spermatocele.
Incise the visceral tunica vaginalis covering the spermatocele.
Circularly dissect the spermatocele without damaging the surrounding epididymal tissue. Ligate the basis of the spermatocele.
Close the visceral tunica vaginalis with a running suture Vicryl 4-0. Consider a closed suction drain after extensive dissection or bleeding diasthesis.
Close the parietal tunica vaginalis and subcutis (Tunica dartos) with a running suture (Vicryl 3-0). Skin sutures.

**Spermatocelectomy:** Incision of the tunica vaginalis visceralis and circular mobilization of the spermatocele.
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**Spermatocelectomy:** Ligature and transection of the base of the spermatocele.
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**Spermatocelectomy:** Closure of the tunica vaginalis visceralis.
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Complications of Spermatocelectomy

Bleeding and hematoma (up to 10%)
Infection (3-5%)
Recurrence of spermatocele, formation of hydrocele
Sperm granuloma, Obstruction of the epididymal duct with infertility.
Chronic pain
Testicular atrophy due to vascular injury is rare.

Hydrocelectomy

Index

Vasectomy

Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

References

J. A. Smith, S. S. Howards, G. M. Preminger, and R. R. Dmochowski, Hinman’s Atlas of Urologic Surgery Revised Reprint. Elsevier, 2019.

Swartz MA, Morgan TM, Krieger JN. Complications of scrotal surgery for benign conditions. Urology. 2007 Apr;69(4):616-9. doi: 10.1016/j.urology.2007.01.004.

Deutsche Version: Operative Therapie der Spermatozele