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Spermatocoele

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Spermatocoele

  1. 1. Spermatocoele Benign cystic accumulation of sperm Arises from the head (caput)of the epididymis-on superior aspect. Lesions are benign – retention cysts Usually uniclocular Contain barley water like fluid- spermatozoa
  2. 2. Sites Testicle- intrascrotal , paratesticular cystic collections of sperm that arise from the epididymis.Along the course of the vas deferens
  3. 3. Aetiology remains undefined In a mouse model - occluded by agglutinated germ cells. Physical trauma, inflammation Epidydimal scarring obstruction spermatocoele In utero exposure to diethylstilbestrol (DES)
  4. 4. Hypotheses- arise from efferent ductules, aneurysmal dilatations of the epididymis, dilatation secondary to distal obstruction
  5. 5. Clinical featuresSymptoms Typically asymptomatic Incidental findings examination Usually a painless mobile swelling posterosuperiorly Associated symptoms scrotal heaviness and dull discomfort
  6. 6. Signs Smooth and spherical Fluctuant Transilluminate on examination
  7. 7. Investigation Uncomplicated asymptomatic spermatocele no investigation needed If scrotal pain urine analysis to rule out epididymitis. FNAC-dead sperm
  8. 8. Ultrasonography Cystic lesions that arise from the epididymal head Less 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.
  9. 9. Scrotal USS - spermatocele visible to the left of a normal testis.
  10. 10.  Color Doppler -"falling snow" appearence (internal echoes moving away from the transducer) Histologic Findings -fibromuscular wall that is lined by cuboidal epithelium
  11. 11. TreatmentMedical Therapy No specific medical therapy . Oral analgesics If an underlying epididymitis - antibiotics Observation is usually used for simple, small asymptomatic spermatoceles.
  12. 12. Surgical TherapySpermatocelectomy The primary operative intervention Via a transscrotal approach Relative contraindications - Systemic anticoagulation -family incomplete
  13. 13.  Performed on an outpatient basis With either regional or general anesthesia Complication- infertility, hematoma, infection, swelling, recurrence, and pain.SPAS(Spermatocele aspiration) high recurrence rate
  14. 14. Intraoperative view of spermatocele with adjacent testicle and spermatic cordSpermatocele after completeexcision
  15. 15. Sclerotherapy Alternative to excision Less effective. For men who have no desire for future paternity Sclerosing agent coaptation cyst walls Tetracycline, fibrin glue, phenol, sodium tetradecyl sulfate (STD)
  16. 16.  A 65% success rate is quotedComplication chemical epididymitis epididymal damage infertility Bleeding, infection ,spermatocele recurrence,scrotal wall thickness.
  17. 17. DD Epididymal cyst- multilocular, contain clear fluid,brilliant transluminence is obtained Hydrocoele Varicocoele Complete inguinal hernia

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