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Spermatocele: Cyst of the Epididymis

Review literature: (Rubenstein et al., 2004).

Definition

Spermatoceles are cysts of the epididymis, which arise from the epididymal duct and contain sperm.

Epidemiology of Spermatoceles

The prevalence in ultrasound screening studies is 10%. The prevalence of spermatoceles increases with age (up to 30%).

Signs and Symptoms

• Painless testicular swelling
• Positive transillumination
• Seldom: disturbing size or pain

Diagnosis of Spermatoceles

Ultrasound imaging:

Ultrasound imaging is very useful for differential diagnosis of scrotal swelling. Spermatoceles present with an anechoic cystic mass, in contact with the epididymis.

Treatment of Spermatoceles

Indication for surgery:

Disturbing size or pain.

Contraindication for surgery:

Patients with unfulfilled desire for a child: Spermatocelectomy causes (with a high probability) sterility on the operated side. Delayed repair or cryopreservation of sperm is recommended, if fertility is an issue.

Surgical technique of spermatocelectomy

The testis is delivered through a scrotal incision. Resection of the spermatocele is done with careful dissection between spermatocele and epididymis. The ligation of final attachments of the spermatocele prevents granuloma formation. The operation is finished with the closure of the tunica vaginalis, tunica dartos (subcutaneous suture) and scrotal skin. Please see section spermatocelectomy.

Puncture of the Spermatocele with Sclerotherapy

Sclerotherapy of spermatoceles is not a standard therapy and has been tested only in small studies.

References