What Is Spermatocele

A spermatocele is a benign growth that forms above or behind the testicle. It is noncancerous. Often, individuals may not experience any symptoms or be aware of a spermatocele. Medical professionals typically opt for treatment only if a sizable spermatocele causes pain or discomfort

Pronounced SPUR-muh-toe-seel, it refers to an unusual cyst that forms within the epididymis, a small, twisted tube situated above the testicle responsible for gathering and moving sperm. Typically benign and causing little to no discomfort, a spermatocele usually contains a fluid that can be milky or clear and may contain sperm.

Spermatoceles may develop either above or behind the testes (testicles).Alternative terms for spermatoceles include spermatic cysts or epididymal cysts.

Typically, spermatoceles do not cause pain, making it possible not to detect a lump immediately. However, discovering a lump around the testicle can be concerning even if it's not painful. It's important to consult a healthcare professional if you observe any alterations in your testicles. Initiating a conversation with a healthcare provider about any testicular changes is the initial step in receiving an official diagnosis for a spermatocele and alleviating any anxieties or worries.

Introduction

Definition of spermatocele

A spermatocele is a prevalent cystic condition found in the scrotum. Typically, it manifests on the head of the epididymis, the duct in which sperm travels, often as a result of partial or complete blockage. In less common instances, it may originate from the tubules of the rete testis, smaller, more delicate ducts that connect to the epididymis, or other irregular ducts.¹

Prevalence and occurrence

This condition typically presents subtle, and its diagnosis often occurs by chance. Nevertheless, spermatoceles are observed frequently, with some authors reporting an incidence of around 30% among men who undergo scrotal ultrasound scans for various reasons. Spermatoceles are most commonly observed in men aged between 65 and 74 years, classifying it as a condition that predominantly affects elderly men.²

Understanding spermatoceles

Anatomy of the male reproductive system

The testes, also known as testicles, are the male reproductive glands situated within a pouch-like extension of the scrotum. These glands are oval-shaped and typically measure between four to six centimetres in length. The scrotum often exhibits asymmetry, with one testis descending further than the other.¹

How spermatoceles develop

The precise cause of spermatoceles remains somewhat unclear, but they are often attributed to obstructions within the tubes responsible for transporting sperm.

Spermatoceles, occasionally referred to as spermatic cysts, are relatively common. They generally do not have a significant impact on fertility and often do not necessitate treatment. In cases where a spermatocele becomes sufficiently large to cause discomfort or pain, surgical intervention may be recommended by a healthcare professional.³

Symptoms and diagnosis

Common symptoms

Men who develop spermatoceles frequently remain asymptomatic. However, if symptoms do manifest, they likely include sensations of heaviness or a dull, lingering discomfort in the scrotal area rather than sharp or acute pain.⁴

Physical examination

Spermatoceles are frequently discovered either during a man's testicular self-examination or as part of a routine health examination conducted by a healthcare professional. It is recommended that individuals perform self-examinations at least once a month, and your healthcare provider can instruct you on the correct technique. If you observe any suspicious changes during these self-exams, such as an increase in size or an unusual firmness, it is advisable to contact your healthcare provider.⁴

Diagnostic tests (Ultrasound, transillumination)

In some cases, a light can be used to shine through a spermatocele. This is done to assess whether the mass appears solid, like a tumour, or benign (non-cancerous), like a cyst. However, a more reliable and thorough method for evaluating a cyst is through ultrasound, a noninvasive and cost-effective diagnostic technique that employs sound waves to generate images of the affected area.⁴

Causes and risk factors

Factors leading to spermatocele formation

The exact cause of spermatoceles remains unknown. It is postulated that these cystic formations may arise due to a blockage in one of the numerous tubules within the epididymis, which are responsible for the transport and storage of sperm originating from the testicle.⁴

Treatment options

Spermatoceles typically do not cause pain and often go unnoticed, so treatment is rarely necessary. In cases where treatment is warranted, there are several options available:

1. Medical Therapy:

Oral pain relievers or anti-inflammatory drugs may be used to alleviate pain associated with spermatoceles. No specific medication is available to cure or prevent spermatoceles.⁴

2. Minimally Invasive Therapies:

Aspiration involves puncturing the spermatocele with a needle to remove its contents.

Sclerotherapy entails injecting an irritating substance into the spermatocele sac to induce healing or scarring, reducing the likelihood of fluid accumulation.

These treatments have shown effectiveness but are generally not recommended due to the risk of harming the epididymis (the tube that stores sperm), which could lead to fertility issues. Additionally, spermatoceles may recur after these procedures.⁴

3. Surgical Therapy (Spermatocelectomy):

Spermatocelectomy is the standard treatment for symptomatic spermatoceles. The objective of surgery is to remove the spermatocele from the epididymal tissue while preserving the reproductive tract. This outpatient procedure is typically performed under local or general anaesthesia and usually takes less than one hour. In some cases, a portion or the entire epididymis may need to be removed.

After treatment:

• Patients are usually provided with a supportive dressing, like an athletic supporter filled with gauze, to be worn for 1 to 2 weeks after surgery.
• Ice packs can be applied for 2 to 3 days to reduce swelling, and pain medications are often prescribed for 1 to 2 days post-surgery.
• Showering is typically allowed 48 hours after the procedure.
• A follow-up visit with the surgeon is usually scheduled between 1 and 3 weeks after the surgery.
• Some scrotal swelling is normal and can persist for 2 to 21 days.

While complications from surgery are uncommon, they may include fever, infection, bleeding (scrotal hematoma), or persistent pain.

In about 10 out of 25 cases, spermatoceles may reoccur, and there's a risk of epididymal blockage, potentially leading to fertility problems, therefore, surgery should be avoided in those who still wish to have biological children.⁴

Complications and prognosis

Potential complications

While complications from surgery are uncommon, they may include fever, infection, bleeding (scrotal hematoma), or persistent pain.⁴

Long-term outlook and fertility

In about 10 out of 25 cases, spermatoceles may reoccur, and there's a risk of epididymal blockage, potentially leading to fertility problems. Therefore, surgery should be avoided in those who still wish to have children.⁴

Prevention and lifestyle considerations

While there's no guaranteed way to prevent the occurrence of a spermatocele, it's crucial to conduct regular scrotal self-examinations, ideally on a monthly basis, to identify any changes or masses in your scrotal area. The discovery of a new mass in your scrotum should prompt immediate evaluation.

Your healthcare provider can provide thorough guidance on how to perform a testicular self-examination, which significantly enhances the likelihood of identifying any abnormalities. If you would like to perform a self-examination, here’s how you can examine your testicles:

Stand in front of a mirror and inspect the skin of the scrotum for any signs of swelling.

With both hands, carefully examine each testicle. Place your index and middle fingers beneath the testicle while positioning your thumbs on top.

1. Gently roll the testicle between your thumbs and fingers. Normally, testicles are smooth, oval-shaped, and moderately firm. If your testicle is abnormally shaped or overly firm, it is best to consult a healthcare professional. It's also typical for one testicle to be slightly larger than the other. The cord extending upward from the top of the testicle, known as the epididymis, is a normal part of the scrotum.³
2. By consistently performing this self-examination, you become more acquainted with your testicles and can promptly identify any concerning changes. If you happen to discover a lump or any irregularity, it's essential to contact your healthcare provider as soon as possible.

It's crucial to understand that while regular self-examinations are a valuable health practice, they do not substitute for a thorough examination by a medical professional. Typically, your doctor will examine your testicles during a routine physical examination to ensure your continued health.

Summary

Spermatoceles, commonly called spermatic cysts, are fluid-filled masses that typically develop near the testicles. These cysts are often painless and are generally benign, meaning they are not cancerous. They are located near the top and rear of the testicle but are distinct from the testicle itself. Spermatoceles can have a smooth texture, contain whitish or cloudy fluid, and frequently store sperm. Their size can vary among individuals. In cases where their size becomes bothersome or causes discomfort, there are treatment options available to address the issue. It's important to note that, in most instances, spermatoceles are not considered a serious medical concern.