SPERMATOCELES

Spermatoceles are benign cysts of the scrotum (from "spermato", for sperm, and "cele", for cavity). They are very common, and more often than not need no treatment. Spermatoceles are not cancerous nor will they become cancerous. They are often confused with hydroceles, another benign cystic disease of the scrotum.

Anatomy

Normally every male has two testicles within the scrotum. Their main functions are to produce the male hormone testosterone and to produce sperm. The hormonal aspects of the testicles are unrelated to spermatoceles. The sperm production aspects are related.

After sperm is produced in the testicles, they migrate into a gland called the epididymis. The epididymis is a small tubular gland about one-and-a-half inches long, and as thick as a pencil. The epididymis lies behind the testicle, and is a series of microscopic tubes that if unfolded would be many hundred feet long. It is here that the sperm, released by the testicle, mature. The maturation process takes about six weeks. At the end of the epididymis is the vas or vas deferens, the single duct or tube that transports the sperm towards the prostate gland, where it joins the seminal fluid produced. Sperm is only a small component of semen volume. Most of the fluid that is ejaculated comes from the prostate gland, which is located inside the body beneath the bladder.

Causes

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.

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.