SPERMATOCELE

What is it?

Spermatoceles are benign cysts of the scrotum (from "spermato", for sperm, and "cele", for cavity).. Spermatoceles are not cancerous nor will they become cancerous. They are often confused with hydroceles, another benign cystic disease of the scrotum.

Who gets it?

They are very common and only occur in men.

What are the symptoms?

The epididymis is the source of spermatoceles. For a number of reasons (e. g. trauma, infection, and congenital abnormalities) one of the tubes of the epididymis no longer transports sperm properly. The end result is a widening of the tube into a small cavity, or cyst. This can be compared to the effects of a dam that creates a lake by obstructing the flow of water.

As time goes on, the cyst can continue to enlarge. In many instances spermatoceles remain small, less than one-half an inch or so, and when they remain small they are usually called "epididymal cysts". In other instances the spermatoceles continue to enlarge and can become five to six inches or larger in size.

Most of the time spermatoceles are painless. However, they can enlarge enough to make clothing uncomfortable, or at least tight fitting in the wrong places.

What is the treatment?

Spermatoceles do not go away without treatment. Fortunately, most spermatoceles require no treatment. If the spermatocele is not causing pain or is not so large that clothing is uncomfortable or unsightly, it can be left alone.

If the spermatocele does require treatment, surgical removal is required. Surgery is usually done as an outpatient, and requires less than an hour to perform. A general spinal, or even local, anaesthetic can be used for the procedure. Most patients will need to stay off their feet for three to five days and to reduce activity for a week.

Risks of the surgery include the bleeding, pain and infection associated with any surgical procedure. Unique risks include recurrence of the spermatocele. Since the epididymis is left in place, there is the possibility of another duct blocking at a later time. The recurrence rate is about five per cent. If the epididymis is removed with the spermatocele, the recurrence rate is lower, but then there is an slight increase in risk of damage to the blood supply to the testicle.

Because the epididymis is an integral part of the sperm transport system, any surgery done near the epididymis could cause occlusion of the duct, similar to having a vasectomy on that side. If fertility is not a concern, then epididymal trauma is not a risk. If the patient is still considering having children, spermatocelectomy should be put off until all childbearing is completed. Hormone problems after spermatocele removal is a very unlikely event, and would only occur in the rare event that the blood supply to the testicle is damaged.