A spermatocele, also known as a spermatic cyst, is a benign growth that develops on the epididymis, the coiled tube located on the upper side of the testicle in which sperm is stored. Most spermatoceles are small and contain a milky fluid that may or may not contain sperm. Although usually harmless, they may sometimes enlarge and cause pain, in which case they may require treatment.

Causes of a Spermatocele

The precise reason spermatoceles develop is unknown, but possible causes may include a blockage within the tubes that drain sperm into the epididymis. Such a blockage may result from traumatic injury or inflammation, or from fetal exposure to diethylstilbestrol (DES), a synthetic form of estrogen used decades ago to prevent miscarriages. A spermatocele may also be a consequence of a vasectomy.

Symptoms of a Spermatocele

Most men who develop spermatoceles do not experience any symptoms. Some patients may experience heaviness or dull pain within the scrotum, or may be able to palpate a mass behind and above the affected testicle.

Diagnosis of a Spermatocele

Most spermatoceles are discovered during a self-examination of the testicles or during a routine medical examination. Even though a spermatocele may not be generally uncomfortable, the patient may experience discomfort when the mass is palpated. It is important that a spermatocele be definitively diagnosed to rule out more serious causes for the swelling, such as a testicular tumor. Other tests that may be performed for this purpose are transillumination and ultrasound.

During transillumination, the doctor shines a light through the patient's scrotum. This light will provide confirmation that the mass is not a solid tumor but a fluid-filled mass. In cases where the results of transillumination are not conclusive, an ultrasound may be performed. During the ultrasound test, high-frequency sound waves create precise images of the region that can be used to make certain whether the mass is solid or only filled with fluid.

Treatment of a Spermatocele

While a spermatocele will not normally disappear on its own, it does not usually require any serious treatment. Any pain the patient experiences normally can be treated effectively with oral analgesics or anti-inflammatory medication. In cases where a spermatocele enlarges or becomes more troublesome, there are several methods that can be used to remove it. These include:

  • Surgery
  • Aspiration
  • Sclerotherapy

Surgery to remove a spermatocele is a straightforward method of correcting the problem. During the surgical procedure, which may be performed under either local or general anesthesia, the urologist makes an incision in the scrotum, separates the spermatocele from the epididymis and removes it. In a less common procedure, the physician may remove the spermatocele by puncturing it with a surgical needle and withdrawing its contents with a syringe, a process known as aspiration.

The third technique is most frequently used when a cyst that has already been aspirated fills with fluid for a second time. In such a case, the physician may aspirate the spermatocele again, but this time inject as irritating chemical back into the hollowed sac. This irritating chemical, called a sclerosing agent, causes scarring, decreasing the risk that the spermatocele will refill. Sclerotherapy is normally used only in men who do not plan to reproduce.

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