SPERMATOCOELE

Spermatocoele

Benign cystic accumulation of sperm

Arises from the head (caput)of the epididymis-on superior aspect.

Lesions are benign – retention cystsUsually uniclocularContain barley water like fluid-spermatozoa

Sites

Testicle- intrascrotal , paratesticular cystic

collections of sperm that arise from the epididymis.

Along the course of the vas deferens

Aetiology remains undefinedIn a mouse model - occluded by

agglutinated germ cells.Physical trauma, inflammation Epidydimal scarring obstruction

spermatocoele In utero exposure to diethylstilbestrol (DES)

Hypotheses- arise from efferent ductules, aneurysmal dilatations of the epididymis, dilatation secondary to distal obstruction

Clinical features

SymptomsTypically asymptomatic Incidental findings examinationUsually a painless mobile swelling

posterosuperiorly Associated symptoms scrotal heaviness

and dull discomfort

SignsSmooth and spherical FluctuantTransilluminate on examination

InvestigationUncomplicated asymptomatic

spermatocele no investigation neededIf scrotal pain urine analysis to rule

out epididymitis. FNAC-dead sperm

Ultrasonography Cystic lesions that arise from the epididymal

headLess commonly- intratesticular lesion attached

to the mediastinum testis.Hypoechoic with posterior acoustic

enhancement and cannot be differentiated from an epididymal cyst .

Occasionally, may have internal echoes within the cyst.

Scrotal USS - spermatocele visible to the left of a normal testis.

Color Doppler -"falling snow" appearence (internal

echoes moving away from the transducer)Histologic Findings -fibromuscular wall that is lined by

cuboidal epithelium

Treatment Medical TherapyNo specific medical therapy . Oral analgesics If an underlying epididymitis -

antibiotics Observation is usually used for simple,

small asymptomatic spermatoceles.

Surgical Therapy

Spermatocelectomy The primary operative intervention Via a transscrotal approachRelative contraindications - Systemic anticoagulation -family incomplete

Performed on an outpatient basisWith either regional or general

anesthesia Complication-infertility, hematoma,

infection, swelling, recurrence, and pain.

SPAS(Spermatocele aspiration)high recurrence rate

Intraoperative view of spermatocele with adjacent testicle and spermatic cord

Spermatocele after complete excision

Sclerotherapy

Alternative to excisionLess effective.For men who have no desire for future

paternity Sclerosing agent coaptation cyst walls

Tetracycline, fibrin glue, phenol, sodium tetradecyl sulfate (STD)

A 65% success rate is quoted Complication

chemical epididymitis epididymal damage infertility

Bleeding, infection ,spermatocele

recurrence,scrotal wall thickness.

DDEpididymal cyst- multilocular, contain

clear fluid,brilliant transluminence is obtained

HydrocoeleVaricocoeleComplete inguinal

hernia

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