Spermatocele - Clinicals, Diagnosis, and Management

Urology

Clinicals - History

Fact Explanation
Scrotal swelling The swelling usually lies in the head of the epididymis superior and posterior to the pole of the testis.
Usually a small swelling that is found incidentally. It may rarely be large enough for the patient to complain that he has grown a third testis.
Spermatocele is often bilateral but causes asymmetrical swellings; therefore the patient may not notice the swelling of the contralateral scrotum.
Scrotal swelling
The swelling usually lies in the head of the epididymis superior and posterior to the pole of the testis.
Usually a small swelling that is found incidentally. It may rarely be large enough for the patient to complain that he has grown a third testis.
Spermatocele is often bilateral but causes asymmetrical swellings; therefore the patient may not notice the swelling of the contralateral scrotum.
Pain This is a rare complaint, most spermatoceles are painless but patients between 30-40 years may present with pain. This may even be due to constant palpation of the swelling out of anxiety. Pain
This is a rare complaint, most spermatoceles are painless but patients between 30-40 years may present with pain. This may even be due to constant palpation of the swelling out of anxiety.
Age usually greater than 40 years Commonly seen in this age group though it may rarely be encountered in children or adolescents.
The cause for a spermatocele remains unknown. It is speculated that it may be a relic of a past inflammatory process or blockage of the epididymal ducts that causes proximal dilatation.
Age usually greater than 40 years
Commonly seen in this age group though it may rarely be encountered in children or adolescents.
The cause for a spermatocele remains unknown. It is speculated that it may be a relic of a past inflammatory process or blockage of the epididymal ducts that causes proximal dilatation.

Clinicals - Examination

Fact Explanation
Scrotal swelling Felt as a smooth, freely mobile, cystic swelling that is confined to the scrotum.
Size can vary from 1-2 cm to a large swelling with a diameter of 15cm.
Can palpated on the postero-superior aspect of the testis distinctly separate from the testis. The spermatic cord can be palpated and feels normal.
Scrotal swelling
Felt as a smooth, freely mobile, cystic swelling that is confined to the scrotum.
Size can vary from 1-2 cm to a large swelling with a diameter of 15cm.
Can palpated on the postero-superior aspect of the testis distinctly separate from the testis. The spermatic cord can be palpated and feels normal.
Multilocularity Is felt as a lobular swelling and does not form a perfect sphere. This is due to the multiple and multilocular nature of epididymal cysts and spermatoceles. In some instances individual loculi may be felt and can be described as elongated, bosselated swellings. Multilocularity
Is felt as a lobular swelling and does not form a perfect sphere. This is due to the multiple and multilocular nature of epididymal cysts and spermatoceles. In some instances individual loculi may be felt and can be described as elongated, bosselated swellings.
Transillumination Illuminates very effectively as the fluid collected within the epididymis is clear. Transillumination
Illuminates very effectively as the fluid collected within the epididymis is clear.
Swelling of the contralateral scrotum Spermatoceles are often bilateral but usaully asymmetrical. Therefore examination of the contralateral hemi-scrotum may reveal a small, freely mobile, cystic mass with a smooth bosselated surface that can be palpated separately from the testis. The swelling is transilluminant and consistent with the diagnosis of a spermatocele. Swelling of the contralateral scrotum
Spermatoceles are often bilateral but usaully asymmetrical. Therefore examination of the contralateral hemi-scrotum may reveal a small, freely mobile, cystic mass with a smooth bosselated surface that can be palpated separately from the testis. The swelling is transilluminant and consistent with the diagnosis of a spermatocele.

Investigations - Diagnosis

Fact Explanation
Aspiration of fluid from the cyst A spermatocele contains dead spermatozoa. This gives it a 'barley water' appearance. This investigation is not usually carried out as it is painful and distressing to the patient. In addition the distinction between a spermatocele and epididymal cyst is only of academic interest as management options are identical. Aspiration of fluid from the cyst
A spermatocele contains dead spermatozoa. This gives it a 'barley water' appearance. This investigation is not usually carried out as it is painful and distressing to the patient. In addition the distinction between a spermatocele and epididymal cyst is only of academic interest as management options are identical.
Ultra sound scan This investigation is not essential as the diagnosis of a spermatocele is based on clinical findings. However sonography is highly sensitive in the detection of spermatoceles and is primarily used rule out the possibility of a testicular tumor. Ultra sound scan
This investigation is not essential as the diagnosis of a spermatocele is based on clinical findings. However sonography is highly sensitive in the detection of spermatoceles and is primarily used rule out the possibility of a testicular tumor.
Color doppler sonography This investigation is used in research studies to enhance the presumptive diagnosis of spermatocele. Color doppler sonography
This investigation is used in research studies to enhance the presumptive diagnosis of spermatocele.

Investigations - Management

Fact Explanation
Seminal Fluid Analysis (SFA) There is a significant risk of epididymal injury following spermatocelectomy. This necessitates that patient counseling be performed pre-procedurally since epididymal injury may lead to infertility. Follow-up after 6 weeks with an SFA in a patient an epididymal injury is suspected is recommended. Seminal Fluid Analysis (SFA)
There is a significant risk of epididymal injury following spermatocelectomy. This necessitates that patient counseling be performed pre-procedurally since epididymal injury may lead to infertility. Follow-up after 6 weeks with an SFA in a patient an epididymal injury is suspected is recommended.

Management - Supportive

Fact Explanation
Conservative management Reassure the patient of the benign nature of the cyst and advise to ignore the swelling. Surgical management is only indicated if their is intractable scrotal pain or if large cysts become troublesome or cosmetically unacceptable. Conservative management
Reassure the patient of the benign nature of the cyst and advise to ignore the swelling. Surgical management is only indicated if their is intractable scrotal pain or if large cysts become troublesome or cosmetically unacceptable.

Management - Specific

Fact Explanation
Percutaneous sclerotherapy Percutaneous sclerotherapy using Polidocanol is the ideal sclerosing agent for superficial and delicate structures, such as epididymal cysts due to its local anesthetic properties. Other agents include talc, sodium tetradecyl sulfate, tetracycline, fibrin glue, phenol, quinine, and ethanolamine oleate. Percutaneous sclerotherapy
Percutaneous sclerotherapy using Polidocanol is the ideal sclerosing agent for superficial and delicate structures, such as epididymal cysts due to its local anesthetic properties. Other agents include talc, sodium tetradecyl sulfate, tetracycline, fibrin glue, phenol, quinine, and ethanolamine oleate.
Spermatocelectomy Indicated only is the cyst is large, obtrusive and cosmetically unacceptable to the patient. There is a significant risk of epididymal injury that may lead to infertility. Spermatocelectomy
Indicated only is the cyst is large, obtrusive and cosmetically unacceptable to the patient. There is a significant risk of epididymal injury that may lead to infertility.
Microsurgical spermatocelectomy A microsurgical approach minimizes injury to the epididymis and testicular blood supply. Which reduces post operative complications such as infertility. Microsurgical spermatocelectomy
A microsurgical approach minimizes injury to the epididymis and testicular blood supply. Which reduces post operative complications such as infertility.

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