FOR MORE MEDICAL PRESENTATIONS AND VIDEOS http://medicalpresentation.blogspot.in/

3. 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

4. Sites
 Testicle-
intrascrotal , paratesticular cystic
collections of sperm that arise from
the epididymis.
Along the course of the vas deferens

5. 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)

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

7. Clinical features
Symptoms
 Typically asymptomatic
 Incidental findings examination
 Usually a painless mobile swelling
posterosuperiorly
 Associated symptoms scrotal heaviness
and dull discomfort

8. Signs
 Smooth and spherical
 Fluctuant
 Transilluminate on examination

9. Investigation
 Uncomplicated asymptomatic
spermatocele no investigation needed
 If scrotal pain
urine analysis to rule
out epididymitis.
 FNAC-dead sperm

10. 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.

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

13.  Color Doppler
-"falling snow" appearence (internal
echoes moving away from the transducer)
 Histologic Findings
-fibromuscular wall that is lined by
cuboidal epithelium

15. Treatment
Medical Therapy
 No specific medical therapy .
 Oral analgesics
 If an underlying epididymitis - antibiotics
 Observation is usually used for
simple, small asymptomatic
spermatoceles.

16. Surgical Therapy
Spermatocelectomy
 The primary operative intervention
 Via a transscrotal approach
 Relative contraindications
- Systemic anticoagulation
-family incomplete

17.  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

18. Intraoperative view of
spermatocele with adjacent
testicle and spermatic cord
Spermatocele after complete
excision

19. 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)

20.  A 65% success rate is quoted
Complication
 chemical epididymitis epididymal
damage infertility
 Bleeding, infection ,spermatocele
recurrence,scrotal wall thickness.

21. DD
 Epididymal cyst- multilocular, contain
clear fluid,brilliant transluminence is
obtained
 Hydrocoele
 Varicocoele
 Complete inguinal
hernia