Spermatocoele
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SPERMATOCOELE
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Spermatocoele
Benign cystic accumulation of sperm
Arises from the head (caput)of the epididymis-on superior aspect.
Lesions are benign – retention cystsUsually uniclocularContain barley water like fluid-spermatozoa
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Sites
Testicle- intrascrotal , paratesticular cystic
collections of sperm that arise from the epididymis.
Along the course of the vas deferens
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Aetiology remains undefinedIn a mouse model - occluded by
agglutinated germ cells.Physical trauma, inflammation Epidydimal scarring obstruction
spermatocoele In utero exposure to diethylstilbestrol (DES)
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Hypotheses- arise from efferent ductules, aneurysmal dilatations of the epididymis, dilatation secondary to distal obstruction
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Clinical features
SymptomsTypically asymptomatic Incidental findings examinationUsually a painless mobile swelling
posterosuperiorly Associated symptoms scrotal heaviness
and dull discomfort
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SignsSmooth and spherical FluctuantTransilluminate on examination
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InvestigationUncomplicated asymptomatic
spermatocele no investigation neededIf scrotal pain urine analysis to rule
out epididymitis. FNAC-dead sperm
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Ultrasonography Cystic lesions that arise from the epididymal
headLess commonly- intratesticular lesion attached
to the mediastinum testis.Hypoechoic with posterior acoustic
enhancement and cannot be differentiated from an epididymal cyst .
Occasionally, may have internal echoes within the cyst.
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Scrotal USS - spermatocele visible to the left of a normal testis.
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Color Doppler -"falling snow" appearence (internal
echoes moving away from the transducer)Histologic Findings -fibromuscular wall that is lined by
cuboidal epithelium
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Treatment Medical TherapyNo specific medical therapy . Oral analgesics If an underlying epididymitis -
antibiotics Observation is usually used for simple,
small asymptomatic spermatoceles.
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Surgical Therapy
Spermatocelectomy The primary operative intervention Via a transscrotal approachRelative contraindications - Systemic anticoagulation -family incomplete
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Performed on an outpatient basisWith either regional or general
anesthesia Complication-infertility, hematoma,
infection, swelling, recurrence, and pain.
SPAS(Spermatocele aspiration)high recurrence rate
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Intraoperative view of spermatocele with adjacent testicle and spermatic cord
Spermatocele after complete excision
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Sclerotherapy
Alternative to excisionLess effective.For men who have no desire for future
paternity Sclerosing agent coaptation cyst walls
Tetracycline, fibrin glue, phenol, sodium tetradecyl sulfate (STD)
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A 65% success rate is quoted Complication
chemical epididymitis epididymal damage infertility
Bleeding, infection ,spermatocele
recurrence,scrotal wall thickness.
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DDEpididymal cyst- multilocular, contain
clear fluid,brilliant transluminence is obtained
HydrocoeleVaricocoeleComplete inguinal
hernia
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Thank you...