Spermatocele is a benign cystic accumulation of sperm that arises from the head of the epididymis. It typically presents as an asymptomatic mobile swelling near the testicle. Ultrasound shows a hypoechoic cystic lesion connected to the epididymis. Treatment involves observation for small asymptomatic cases or spermatocelectomy via scrotal surgery to remove the cyst. Sclerotherapy is sometimes used as an alternative but has a higher recurrence rate.

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