Most spermatoceles are asymptomatic. When the cysts have dilated enough to become large and noticeable, they may present as:
Work up consists of a detailed history and physical examination.
Laboratory test are rarely performed. Usually a physical examination and imaging studies are sufficient to form a diagnosis. If the patient also complains of pain during urinating and/or in the scrotum, urinalysis may be done to check for epididymitis.
Ultrasound: Scrotal ultrasound will assist diagnosis if there is uncertainty .
Color Doppler Sonography: Color Doppler may reveal a 'falling snow' sign, resulting from internal echoes moving away from the transducer .
Transillumination: Spermatoceles are transilluminate on examination as they contain fluid.
On the basis of imaging studies and physical examination, spermatoceles can be diagnosed and treatment, if needed, can be started.
This procedure is only performed when the spermatocele is large and poses some discomfort to the patient. It is conducted via a transscrotal approach and is the primary surgical treatment for this condition. The patient must be counselled regarding the risks of infertility, as well as the more common complications of hematoma, infection, swelling, recurrence and pain .
This procedure is less effective than spermatocelectomy. Coaptation of the walls of the cyst, by the help of a sclerosing agent or sclerosant, is done after aspirating the cyst to prevent recurrence. Sclerosants used include tetracycline, phenol and sodium tetradecyl sulphate . Comparative trials have not established any one agent as a superior spermatocele sclerosing agent . It should be noted that this procedure carries more risks and complications than a spermatocelectomy.
Spermatoceles have an excellent prognosis. As they are benign masses, they may not require treatment at all if asymptomatic. If, however, they are symptomatic and/or large in size, they can be successfully treated with surgery.
Complications of spermatoceles are rare. Some of them may include:
Spermatoceles are mainly idiopathic. Several factors have been proposed to be the underlying cause of development of a spermatocele. It is generally accepted, however, that any condition, that blocks one or more of the ducts in the scrotum may result in formation of a spermatocele.
Scarring of any part of the ducts may result in this condition and so can vasectomy. Trauma and inflammation may also cause spermatoceles . Aneurysmal dilatations of the epididymis may also cause the formation of a spermatocele.
Cysts are found in as many as 30% of asymptomatic patients having scrotal ultrasound for other reasons, but most of these are spermatoceles .
Spermatoceles have no known predisposition to age.
Spermatoceles are typically smooth, well circumscribed scrotal masses that may occur anywhere along the vas deferens or somewhere in the ducts of the testis itself.
They most commonly occur from the head, known as the caput, of the epididymis. They contain fluid and varying content of spermatozoa.
Spermatoceles are benign and may go unnoticed unless large in size or painful. They may be of a few millimetres or grow up to be many centimetres wide.
Although the exact etiology is heretofore unknown, it is clear that any factor that results in blockage of one or more of the testicular ducts will eventually predispose to the formation of a spermatocele. Such factors include inflammation, such as epididymisitis, scarring due to vasectomy, trauma to the scrotum, etc.
Spermatoceles can not be prevented from forming unless they are due to an underlying treatable cause such as inflammation.
Spermatocele refers to a small cystic accumulation of semen in dilated efferent ducts or ducts of the rete testis . It usually occurs as a sac like dilatation of a region of the narrow epididymis. The dilated cyst contains clear to cloudy fluid, mostly containing sperms.
A spermatocele is a cyst like dilatation of the ducts inside the scrotum. The cysts can be solitary or many. They contain clear fluid and typically some amount of sperms.
Diagnosis is made on the basis of physical examination and ultrasound.