Most spermatoceles are asymptomatic. When the cysts have dilated enough to become large and noticeable, they may present as:
Entire Body System
We report the very rare case of bilateral spermatoceles concurrent with bilateral scrotal hydrocele presenting huge scrotal swelling. A 52-year-old man came to our hospital because of large scrotal swelling. [ncbi.nlm.nih.gov]
A spermatocele [also called an epididymal cyst] is a fluid swelling above or behind the testicle as a result of the development a cystic swelling from the rete testis. Causes Usually these cystic swellings occur without obvious cause. [metrovanurology.com]
When the patient lies down the veins will empty and the swelling disappears.  [explainmedicine.com]
Medical Therapy Oral pain or anti-swelling drugs may be used to ease pain caused by spermatoceles. No other type of medical therapy is needed. There is no drug to cure or prevent spermatoceles. [urologyhealth.org]
The symptoms that are highly suggestive of spermatocele are pain in testicles, mass in scrotum, swelling of scrotum, retention of urine, groin pain, impotence, leg lump or mass, muscle swelling, low back weakness, and elbow weakness, although you may [symcat.com]
Lungs and wounds inflammation risk, cardiac and lung complications and thrombosis risks have increased in the overweight persons with smoking habit and with uncontrolled diabetes. [kentsaglikgrubu.com]
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. [symptoma.com]
Wall is composed of fibromuscular soft tissue often with chronic inflammation. Cyst fluid contains spermatozoa, which distinguishes a spermatocele from a hydrocele. advertisement advertisement [auanet.org]
Epididymis inflammation (epididymitis) Erectile dysfunction Hydrocele Paraphimosis (unable to pull foreskin over penis) Penile cancer (carcinoma of the penis) Testicular cancer Testicular Torsion Varicose veins in the scrotum (varicocele) [uroviva.ch]
Most spermatoceles are asymptomatic. [symptoma.com]
Spermatoceles are usually asymptomatic and often found incidentally during physical examination. We report a case of giant spermatocele that mimicked a hydrocele. A 55-year-old man suffered from right scrotal enlargement for several years. [ncbi.nlm.nih.gov]
Treatment Small cysts of the epididymis are best left alone, as are larger cysts when asymptomatic. [healthcentral.com]
Investigation Uncomplicated asymptomatic spermatocele no investigation needed If scrotal pain urine analysis to rule out epididymitis. FNAC-dead sperm 8. [fr.slideshare.net]
Presentation Typically, spermatoceles are asymptomatic. They are often incidental findings on testicular self-examination or routine physical examination. [emedicine.medscape.com]
[…] testicle or scrotum Blood collection or infection around the testicle Pus collection and abscess formation Impaired fertility or infertility Recurrence of spermatocele (rare) When to Call the Office Contact your surgeon immediately if you experience fever [oregonurologyalliance.com]
[…] scrotal pain that is often associated with nausea and vomiting. On examination the testis on the affected side will appear to be in a higher position within the scrotum.  Epididymoorchitis Presents with gradual development of scrotal pain, with fever [explainmedicine.com]
Side effects from surgery are not common, but can involve fever, infection, bleeding (scrotal hematoma), and lasting pain. Spermatoceles can come back in about 10 ouy of 25 cases. [urologyhealth.org]
Potential complications of spermatocelectomy are not common but include fever, infection, bleeding (scrotal hematoma), recurrence and persistent pain. Recurrence of a spermatocele occurs in approximately 10-25% of cases. [uropartners.com]
- Severe Pain
Your provider may ask you to check for changes, lumps, or pain. Ask for more information on how to do a testicular self-exam. When should I seek immediate care? You have sudden, severe pain in your scrotum or testicle. [drugs.com]
Sclerotherapy Potential complications of sclerotherapy include the following: Epididymal injury Infertility Bleeding Infection Chemical epididymitis Spermatocele recurrence Postprocedure, minor pain was noted in 10%, moderate pain in 4%, and severe pain [emedicine.medscape.com]
Patients with a testicular mass may present with a painless lump or scrotal pain, which can range from severe pain to a dull ache that worsens with exercise. The pain may be localized or may radiate along the spermatic cord into the lower abdomen. [aafp.org]
The second is sclerotherapy which involves injecting an irritating agent into the cyst promoting healing and discouraging fluid from collecting again. [advancedurology.com]
If the spermatocele recurs, your doctor might recommend aspirating the fluid again and then injecting an irritating chemical into the sac (sclerotherapy). [mayoclinic.org]
It is also possible to try sclerotherapy during which the doctor first performs removal of the fluid form the cyst and he/she then injects an irritating chemical which induces scarring of the cyst. [ic.steadyhealth.com]
Acute inflammatory processes involving the epididymis or testicle such as epididymitis, orchitis, or testicular torsion, are associated with a high degree of pain and should not be confused with spermatocele. [healthcentral.com]
Occasionally, an intratesticular varicocele may be confused with these lesions; however, color flow and duplex Doppler ultrasound show the venous flow pattern with a characteristic venous spectral waveform that increases during a Valsalva maneuver. 12 [appliedradiology.com]
Spermatocele Differential Diagnosis The following conditions may be confused with this type of cyst as they have similar symptoms: Hydrocele Varicocele Testicular Cancer Inguinal Hernia Simple Epididymal Cyst Neoplasm Epididymitis Hematocele Orchitis [primehealthchannel.com]
- Scrotal Mass
Located at the superior pole of the testis and caput epididymis, the spermatocele is soft and fluctuant and can be transilluminated (a flashlight can be seen if shined through the scrotal mass). [healthcentral.com]
Left scrotal mass Lack of recurrence after 4 years of follow-up Tunuguntla et al. [ 2 ] 17 Radical orchidectomy Left scrotal mass Our case 42 Vimentin (+), SMA (+), CD68 (+), ALK (−) Local excision Left scrotal mass Lack of recurrence after a year of [ncbi.nlm.nih.gov]
Abnormalities within the male reproductive tract may appear as scrotal masses. Masses may be of little significance or may represent life-threatening illnesses. [uropartners.com]
- Swelling of the Scrotum
The heat from the water relaxes your scrotum, making it easier for you to detect anything unusual. Then follow these steps: Stand in front of a mirror. Look for any swelling on the skin of the scrotum. Examine each testicle with both hands. [mayoclinic.org]
On examination, the epididymis is exquisitely tender, the scrotum is erythematous and warm while elevation of the scrotum may provide relief of pain.  Inguino-scrotal hernia The swelling is not confined to the scrotum and extends upwards in to the [explainmedicine.com]
These are too similar conditions of fluid swelling in the scrotum. [metrovanurology.com]
- Testicular Pain
Rarely, severe groin pain can stem from a serious medical condition, such as cancer or testicular torsion. [my.clevelandclinic.org]
A number of conditions can cause testicular pain, and some require immediate treatment. Causes The cause of spermatoceles is unknown. [mayoclinic.org]
A number of conditions can cause testicular pain, and some require immediate treatment. The cause of spermatoceles is unknown. [fortishealthcare.com]
- Testicular Mass
Testicular cysts: US findings. Radiology. 1987;163:537-538. Brown DL, Benson CB, Doherty FJ, et al. Cystic testicular mass caused by dilated rete testis: Sonographic findings in 31 cases. AJR Am J Roentgenol. 1992;158:1257-1259. [appliedradiology.com]
Family physicians often must evaluate patients with testicular pain or masses. The incidental finding of a scrotal mass may also require evaluation. Patients may seek evaluation of a scrotal mass as an incidental finding. [aafp.org]
However, if a "must not miss" diagnoses related to testicular masses such as testicular torsion, epididymitis, acute orchitis, strangulated hernia and testicular cancer is suspected, the family physician must refer to a urologist. Finding a painless [en.wikipedia.org]
- Urethral Discharge
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.
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.
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.
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- Pais VM, et al. Spermatocele. eMedicine. June 2009.
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- Gunaydin G, Ozyurt C, Kocak I, et al. Anti bacterial activity of the fluid contents of spermatocele and epididymal cysts. Br J Urol. 1995 Jan;75(1):68-70.
- Muttarak M, Chaiwun B; Painless Scrotal Swelling: ultrasonographical features with pathological correlation. Singapore Med J. 2005 April;46(4):196-201; quiz 202.
- Sista AK, Filly RA. Color Doppler sonography for evaluation of spermatoceles: the 'falling snow' sign. J Ultrasound Med. Jan 2008;27(1):141-3
- Kauffman EC, Kim HH, Tanrikut C, Goldstein M. Microsurgical spermatocelectomy: techniques and outcomes of a novel surgical approach. J Urol. Jan 2011; 185(1):238-42.
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- East JM, DuQuesnay D. Sclerotherapy of idiopathic hydroceles and epididymal cysts: a historical comparison trial of 5% phenol versus tetracycline. West Indian Med J. Dec 2007;56(6):520-5