What are Spermatoceles (Spermatic Cysts)?

Spermatocele on the Epididymis
Spermatocele on the Epididymis

Spermatoceles are also known as spermatic cysts. They are fluid-filled masses, often painless, and they grow near the testicles. They tend to be benign (not cancerous). These cysts are found near the top and behind the testicle, but are separate from the testicle. They can be smooth, filled with a whitish, cloudy fluid, and most often hold sperm. Their size can vary. If their size becomes a bother or causes pain, then there are some ways to fix the problem. As a rule, they are not a serious medical issue.

The male reproductive tract handles the growth, maturation and delivery of sperm. Faults in the male reproductive tract can cause a mass to grow. If a mass forms in the scrotum, it may mean nothing or it could be a sign of something serious. A set course of action is needed to learn the nature of the mass and the best treatment. For example, if the mass is testicular cancer, it is a source of great concern and requires action. Other masses, such as varicoceles, can cause pain or harm reproductive function. Spermatocele masses are not cancerous, and do not increase your risk of testicular cancer, but they may be a nuisance.



What are the Signs of a Spermatocele?

Men with spermatoceles often have no symptoms. If there are signs, they may involve feelings of heaviness or dull pain in the scrotum, but not sharp pain.



How are Spermatoceles Diagnosed?

Spermatoceles are often found at a man's testicular self-exam, or by a doctor at a health exam. Self-exams should be done at least once a month. Your health care provider can train you in the right technique. If you note any suspicious changes, such as larger size or unusual firmness, you should call your health care provider.

Light can be shined through a spermatocele. This generally shows if the mass looks like a solid tumor or a benign (not cancerous) cyst. Ultrasound (a test using sound waves to make images of organs) is a better way to check a cyst. This method is relatively quick, noninvasive and inexpensive.



How are Spermatoceles Treated?

Since these cysts, as a rule, do not cause pain and are often not noticed, they rarely need treatment. The basic care for spermatoceles without pain is observation. But some men do have symptoms such as bothersome size or pain. When treatment is needed, there are several choices.

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.

Minimally Invasive Therapies

Aspiration and sclerotherapy are 2 treatments that are available, but are not often used.

  • Aspiration involves puncturing the spermatocele with a needle and drawing out its contents.
  • Sclerotherapy involves injecting an irritating agent into the spermatocele sac. This causes it to heal or scar closed. This lowers the odds of fluid pooling again.

These options have been shown to work but in general, they are not recommended and rarely used. There is a risk of harm to the epididymis (tube that stores sperm), which can lead to fertility problems. Another common problem with both of these methods is that the spermatoceles can come back.

Surgical Therapy

Spermatocelectomy is the standard treatment for spermatoceles that cause symptoms. The goal of surgery is to remove the spermatocele from the epididymal tissue and preserve the reproductive tract. This outpatient procedure is often done with local or general anesthesia. It usually takes less than 1 hour. Sometimes all or a part of the epididymis may need to be removed as well.



What Can Be Expected After Surgery?

You will likely be sent home with a pressure dressing like an athletic supporter filled with fluffy gauze. That support is worn for 1 to 2 weeks after surgery. Ice packs can be used for 2 to 3 days to help with swelling. Drugs for pain are often taken for 1 to 2 days after surgery. You can shower 48 hours after surgery.

A follow up visit with your surgeon is often scheduled between 1 and 3 weeks later. Scrotal swelling is normal and typically lasts for 2 to 21 days. 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. Blockage of the epididymis (tube that stores sperm) may also occur, which can lead to problems with fertility. For these reasons, surgery should be avoided in men who still want children.