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
Sites Testicle- intrascrotal , paratesticular cystic collections of sperm that arise from the epididymis.Along the course of the vas deferens
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)
Hypotheses- arise from efferent ductules, aneurysmal dilatations of the epididymis, dilatation secondary to distal obstruction
Clinical featuresSymptoms Typically asymptomatic Incidental findings examination Usually a painless mobile swelling posterosuperiorly Associated symptoms scrotal heaviness and dull discomfort
Signs Smooth and spherical Fluctuant Transilluminate on examination
Investigation Uncomplicated asymptomatic spermatocele no investigation needed If scrotal pain urine analysis to rule out epididymitis. FNAC-dead sperm
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.
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
TreatmentMedical Therapy No specific medical therapy . Oral analgesics If an underlying epididymitis - antibiotics Observation is usually used for simple, small asymptomatic spermatoceles.
Surgical TherapySpermatocelectomy The primary operative intervention Via a transscrotal approach Relative contraindications - Systemic anticoagulation -family incomplete
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
Intraoperative view of spermatocele with adjacent testicle and spermatic cordSpermatocele after completeexcision
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)
A 65% success rate is quotedComplication chemical epididymitis epididymal damage infertility Bleeding, infection ,spermatocele recurrence,scrotal wall thickness.