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Spermatoceles (Spermatic Cyst)

The male reproductive tract is responsible for the production, maturation and delivery of sperm. Sperm are produced in the testicles and then are transported via a complex and highly integrated entity through the epididymis and vas deferens. Sperm travel through the vas deferens up through the groin and then in the deep pelvis before they enter the ejaculatory duct and then are released through the penis and out of the urethra during ejaculation. Each component of the reproductive tract is highly specialized.

Abnormalities within the male reproductive tract may appear as scrotal masses. Masses may be of little significance or may represent life-threatening illnesses. It is necessary to follow a set course of action to determine the nature of the masses and the most appropriate treatment option. For example, testicular cancer is a source of great concern and uniformly requires prompt intervention. Other masses, such as varicoceles, can cause pain or impair reproductive function. Spermatoceles are benign and generally painless masses that extend near the testicle. Thus, it is important for a patient to seek prompt medical attention when he identifies a scrotal mass or abnormality while performing testicular self examination. The following information will assist you when talking to a urologist about spermatoceles.

What is a spermatoceles?
Spermatocele, also known as a spermatic cyst, are typically painless, noncancerous (benign) fluid filled cysts that are outpocketing of fluid from the epididymis. They usually sit near the top and/or behind the testicle, but appear separate from the testis. Spermatoceles are typically smooth and they are usually filled with a whitish, cloudy fluid and usually contain sperm. Over time, spermatoceles may remain stable in size or they may grow. If in fact the size becomes bothersome, or results in pain, then there are several treatment options to rectify the problem. Spermatoceles are generally no more than a nuisance rather than a serious medical condition.

What can cause spermatoceles?
The precise cause of spermatoceles is not known. While spermatoceles may form as a result of trauma or inflammation, these conditions are certainly not required for spermatocele formation. Others suggest that blockage of the efferent ducts and epididymis result in spermatocele formation. Additionally, in utero exposure to diethylstilbestrol (DES), a synthetic form of estrogen, has also been suggested as a possible cause.

How common are spermatoceles?
The precise incidence of spermatoceles is unknown, but an estimated 30 percent of all men have small spermatoceles with larger sized spermatococeles being much less common.. Incidence increases with age, with peak rates for the diagnosis of spermatoceles occurring in men in their forties and fifties. No racial or ethnic predispositions to spermatocele formation are known.

What are the symptoms of spermatoceles?
Men with spermatoceles usually have no symptoms. However, when associated symptoms are present, they may include scrotal heaviness and/or dull discomfort but usually not sharp pain.

How are spermatoceles diagnosed?
Spermatoceles are typically discovered through a man's self-examination of his testicles or at the time of an evaluation by a physician. Light can be shined through a spermatocele (transillumination), indicating that the mass is not a solid tumor but more likely a benign cyst. Ultrasound examination remains a very reliable means of evaluation and is a relatively quick, noninvasive and inexpensive test.

How are spermatoceles treated?
Since spermatoceles generally do not cause discomfort and often go unnoticed by patients, they RARELY require treatment. The standard treatment for spermatoceles without pain is observation. Nevertheless, some affected individuals do experience significant associated symptoms, such as bothersome size or pain. When intervention is indicated, the available treatment options include:

Medical therapy: Oral analgesics or anti-inflammatory agents may be used to relieve pain associated with symptomatic spermatoceles. No other type of medical therapy is specifically indicated for the treatment of spermatoceles.

Minimally invasive therapies: Aspiration and sclerotherapy are two less commonly utilized approaches to treat spermatoceles. Aspiration involves puncture of the spermatocele with a needle and withdrawal of its contents into a syringe. Sclerotherapy is performed with subsequent injection of an irritating agent directly into the spermatocele sac to cause it to heal or scar closed, removing the spermatocele space which theoretically decreases the odds of fluid reaccumulation. Although several reports describe the effectiveness and tolerability of these treatment options, they are generally not recommended. Spermatocele recurrence is a common complication with both approaches, and chemical epididymitis and pain are common complications with sclerotherapy. Furthermore, aspiration and sclerotherapy have limited applicability in men of reproductive age, due to the significant risk of epididymal damage potentially leading to obstruction and resultant subfertility.

Surgical therapy: Spermatocelectomy is the standard treatment of symptomatic spermatoceles and involves surgical removal of the spermatocele from the adjoining epididymal tissue. The overall goal of surgical therapy is removal of the spermatocele with preservation of the continuity of the male reproductive tract. This an outpatient procedure is usually performed under local anesthesia with sedation or general anesthesia and usually takes less than one hour to perform. Sometimes, the epididymis is removed as well when a spermatocelectomy is performed.

What can be expected after surgical treatment?
Patients are generally discharged home with a pressure dressing consisting of an athletic supporter filled with fluffy gauze. Ice packs are applied for two to three days to minimize swelling. Oral pain medications are generally used for one to two days postoperatively. Patients usually may shower at 48 hours after surgery, and a follow-up visit is scheduled for one to three weeks after the procedure. Patients usually wear a scrotal support for 7-14 days after the procedure. Scrotal swelling is usual and will typically last from 2 -21 days.

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. Furthermore, inadvertent epididymal obstruction may result, which can lead to subfertility or infertility. Therefore, intervention should be avoided in men who still desire children.

Frequently asked questions: 
Do spermatoceles lead to testicular cancer?

Spermatoceles are benign epididymal lesions. They are separate and distinct from the testicle. Patients with spermatoceles do not have an identified increased risk of testicular cancer.

Are any medications available to cure my spermatocele or prevent the formation of additional ones?
Medications are available to treat associated discomfort or pain, but no medication will lead to resolution or prevention of spermatoceles.

How often should I perform scrotal self-exams?
These exams should be performed at least once per month. Your physician can instruct you in the specific technique. If you detect any suspicious changes, such as increasing size or unusual firmness of scrotal structures, contact your physician.



Reviewed: January 2011

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Spermatoceles (Spermatic Cyst) Glossary
  • abnormality: A variation from a normal structure or function of the body.

  • analgesic: A drug intended to alleviate pain.

  • anesthesia: Loss of sensation in any part of the body induced by a numbing or paralyzing agent. Often used during surgery to put a person to sleep.

  • benign: Not malignant; not cancerous.

  • cancer: An abnormal growth that can invade nearby structures and spread to other parts of the body and may be a threat to life.

  • cyst: An abnormal sac containing gas, fluid or a semisolid material. Cysts may form in kidneys or other parts of the body.

  • cysts: Abnormal sacs containing gas, fluid or a semisolid material.

  • diagnosis: The process by which a doctor determines what disease or condition a patient has by studying the patient's symptoms and medical history, and analyzing any tests performed (e.g., blood tets, urine tests, brain scans, etc.).

  • ejaculation: Release of semen from the penis during sexual climax (orgasm).

  • ejaculatory: Involved in or related to the structure involved in the release of semen from the penis during orgasm.

  • ejaculatory duct: The passage through which semen enters the urethra.

  • epididymis: A coiled tube attached to the back and upper side of the testicle that stores sperm and is connected to the vas deferens

  • epididymitis: An inflammation of the epididymis.

  • epididymitis: An inflammation of the epididymitis which is an elongated structure connected to the posterior surface of the testis.

  • estrogen: Female hormone produced by the ovaries.

  • fertility: The ability to conceive and have children.

  • gene: The basic unit capable of transmitting characteristics from one generation to the next.

  • general anesthesia: Person is put to sleep with muscle relaxation and no pain sensation over the entire body.

  • groin: The area where the upper thigh meets the lower abdomen.

  • hematoma: A semisolid mass of blood in the tissues caused by injury, disease or a clotting disorder.

  • infection: A condition resulting from the presence of bacteria or other microorganisms.

  • infertility: The diminished ability or the inability to conceive and have offspring.

  • inflammation: Swelling, redness, heat and/or pain produced in the area of the body as a result of irritation, injury or infection.

  • inflammatory: Characterized or caused by swelling, redness, heat and/or pain produced in an area of the body as a result of irritation, injury or infection.

  • invasive: Having or showing a tendency to spread from the point of origin to adjacent tissue, as some cancers do. Involving cutting or puncturing the skin or inserting instruments into the body.

  • invasive: Not just on the surface; with regard to bladder cancer, a tumor that has grown into the bladder wall.

  • ions: Electrically charged atoms.

  • lesion: A zone of tissue with impaired function as a result of damage by disease or wounding. Examples are scars, abscesses, tumors and ulcers.

  • liver: A large, vital organ that secretes bile, stores and filters blood, and takes part in many metabolic functions, for example, the conversion of sugars into glycogen. The liver is reddish-brown, multilobed, and in humans is located in the upper right part of the abdominal cavity.

  • local anesthesia: Loss of sensation only in one part of the body induced by application of an anesthetic agent.

  • obstruction: something that obstructs, blocks, or closes up with an obstacle

  • pelvis: The bowl-shaped bone that supports the spine and holds up the digestive, urinary and reproductive organs. The legs connect to the body at the pelvis.

  • penis: The male organ used for urination and sex.

  • postoperative: Occurring after a surgical operation.

  • scrotal: Relating to the scrotum, the sac of tissue that hangs below the penis and contains the testicles.

  • scrotal: Relating to the scrotum, the sac of tissue that hangs below the penis and contains the testicles.

  • sedation: State of calm relaxation induced in one or more body systems by administration of medical agents (sedatives).

  • sperm: Also referred to as spermatozoa. Male germ cells (gametes or reproductive cells) that are produced by the testicles and that are capable of fertilizing the female partner's eggs. Cells resemble tadpoles if seen by the naked eye.

  • spermatocele: Cystic swelling in the scrotum containing sperm.

  • stent: With regard to treating ureteral stones, a tube inserted through the urethra and bladder and into the ureter. Stents are used to aid treatment in various ways, such as preventing stone fragments from blocking the flow of urine.

  • symptomatic: Having to do with a symptom or symptoms that arise from and accompany a particular disease or disorder and serves as an indication of it.

  • testicle: Also known as testis. Either of the paired, egg-shaped glands contained in a pouch (scrotum) below the penis. They produce sperm and the male hormone testosterone.

  • testicular: Relating to the testicle (testis).

  • testicular cancer: Cancer of the testis.

  • testis: Also known as testicle. Either of the paired, egg-shaped glands contained in a pouch (scrotum) below the penis. They produce sperm and the male hormone testosterone.

  • tissue: Group of cells in an organism that are similar in form and function.

  • tumor: An abnormal mass of tissue or growth of cells.

  • urethra: A tube that carries urine from the bladder to the outside of the body. In males, the urethra serves as the channel through which semen is ejaculated and it extends from the bladder to the tip of the penis. In females, the urethra is much shorter than in males.

  • urge: Strong desire to urinate.

  • urologist: A doctor who specializes in diseases of the male and female urinary systems and the male reproductive system. Click here to learn more about urologists. (Download the free Acrobat reader.)

  • urology: Branch of medicine concerned with the urinary tract in males and females and with the genital tract and reproductive system of males.

  • varicoceles: Dilated varicose veins in the scrotum that drain the testis and can impair the process of formation of sperm.

  • vas: Also referred to as vas deferens. The cordlike structure that carries sperm from the testicle to the urethra.

  • vas deferens: Also referred to as vas. The cordlike structure that carries sperm from the testicle to the ejaculatory duct, whicn in turn carries it to the urethra.

  • void: To urinate, empty the bladder.

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