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A spermatocele, also referred to as an epididymal cyst, is an atypical growth of a cyst that is filled with fluid and is found in the epididymis. The epididymis is a small, coiled tube located on the upper testicle that collects and transports sperm. Spermatocele is not cancerous. It is usually painless. The fluid inside a spermatocele is usually clear or milky and may contain sperm.
The size of spermatoceles differs.
- Nothing: A few cysts are too small to be felt or seen and therefore only medical imaging, such ultrasound, is able to detect these cysts.
- Pea-sized lump: Many spermatoceles have the appearance of a little bump that lies above or behind a testis. Most resemble peas in size and shape.
- Large growth: Spermatoceles can occasionally get rather big. Some men claim that a big spermatocele resembles a third testicle.
Main functions of epididymis include keeping and delivering sperm from the testicle. Since the exact cause of spermatoceles is unknown, one of the sperm-transporting tubes may have become blocked or inflammed.
Because spermatoceles are benign cysts, they are not cancerous. There is no evidence to suggest that a spermatocele can progress into a malignant (cancerous) growth. Furthermore, having a spermatocele does not increase the likelihood of developing testicular cancer.
Often, the condition does not affect fertility or required treatment. The healthcare provider could advise surgery, if a spermatocele becomes large enough to be uncomfortable.
Symptoms
Spermatocele typically shows no signs and symptoms, and its size may stay unchanged. But if it gets big enough, patient might experience the following:
- Pain or uncomfortable at the affected testicle
- Swelling of the scrotum
- Fullness above and behind the testicle
- Heaviness at the testicle
Spermatocele typically doesn’t cause symptoms, a patient may only become aware of it through a testicular self-exam or a healthcare provider may uncover it during a routine physical examination.
Any scrotal tumor should be examined by a healthcare provider to rule out more serious conditions including testicular cancer. Call the physician if the patient also has pain or swelling in the scrotum. There are several disorders that can cause testicular pain, some of which require immediate medical attention.
Causes
A spermatocele is a condition in which sperm accumulates in a certain area of the epididymis. Spermatoceles may be caused by a blockage in one of the many tubes in the epididymis that store and carry sperm from the testicle.
Risk factors
There aren’t many well-established risk factors for spermatocele development.
- Age: It is common men at age 40 years old and above.
- Medication: The risk increase to those mothers who received the medication diethylstilbestrol (DES) during pregnancy to avoid miscarriage and other pregnancy problems. Concerns regarding a rise in the incidence of uncommon vaginal cancer in females led to the termination of use of this medication.
Diagnosis
Spermatoceles frequently go misdiagnosed, as they frequently have no symptoms. The following may help the healthcare provider properly diagnose the condition.
- Physical examination: Patient will be required a physical examination to identify a spermatocele. Although a spermatocele usually doesn’t hurt, the patient could experience pain when their doctor palpates the tumor. When performing a testicular self-exam, some persons find a spermatocele.
- Laboratory test: A complete blood count (CBC) test or a urine test may be advised by a healthcare provider if a patient complains of testicular pain. These tests look for potential infection or inflammation.
- Transillumination: A light may be shined by the healthcare practitioner through the scrotum. The light will show that a spermatocele has a mass that is fluid-filled rather than solid.
- Ultrasound: With the use of sound waves, this non-invasive imaging procedure, testicular cysts are precisely imaged. An ultrasound can help identify what else it might be if transillumination doesn’t definitively reveal a cyst. This test, which visualizes structures using high-frequency sound waves, may be done to rule out a testicular tumor or another source of scrotal enlargement.
Treatment
The majority of spermatoceles do not necessitate treatment, as they typically do not resolve on their own and are not associated with pain or complications. However, if discomfort is experienced, a doctor may recommend over-the-counter pain relief medications like acetaminophen or ibuprofen to alleviate symptoms.
- Surgical treatment: A spermatocelectomy is often carried out as an outpatient treatment under local or general anesthesia. The spermatocele and epididymis are separated by the surgeon through an incision in the scrotum. Following surgery, the patient may be required to wear a supportive undergarment filled with gauze to apply pressure to and protect the incision site. Patients may also be advised to:
- Apply ice compress for 2 – 3 days to reduce swelling.
- Oral pain medications are recommended for a day or two.
- Follow-up examination is recommended between 1-3 weeks after the operation.
Surgical removal of a spermatocele can result in damage to the epididymis or vas deferens, which can impact fertility by affecting the tube that transports sperm. Additionally, there is a possibility of a reoccurrence of a spermatocele even after surgery.
- Aspiration with or without sclerotherapy: Sclerotherapy and aspiration are other therapies, however they are rarely used. A particular needle is used to aspirate fluid from the spermatocele during the procedure.
If a spermatocele reappears, a healthcare provider may recommend aspiration of the fluid and the injection of a chemical into the sac. This procedure causes scarring in the spermatocele sac, which replaces the fluid and reduces the likelihood of recurrence.
Sclerotherapy may result in damage to the epididymis as a side effect. Also, it’s possible for the spermatocele to return.
- Fertility protection: Sclerotherapy and surgery both have the risk of damaging the epididymis or the vas deferens, which can have an impact on fertility. Some treatments may be postponed until they are done having children. In the event that a patient is experiencing discomfort due to a spermatocele and wishes to take immediate action, they may consult their healthcare provider about the benefits and drawbacks of sperm banking.
