Spermatoceles

Spermatocele is a seminal cyst associated with the epididymis or testicle, a cystic cavity.

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Causes spermatoceles

Spermatoceles may develop from embryonic remnants: pedunculated hydatids located at the upper pole of the testicle, remnants of the Müllerian duct: pedunculated hydatids located at the head of the epididymis - rudiments of the Wolffian body. Cysts are often filled with clear fluid.

Retention seminal cysts can also occur as a result of trauma or inflammation, when the seminal tubules become narrowed or obliterated. Normal and abnormal spermatozoa are found in the contents of these cysts. This type is extremely rare in childhood.

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Symptoms spermatoceles

Children usually do not present any complaints; the diagnosis of spermatocele is usually made during a routine examination.

In case of spermatocele, the testicle and epididymis are determined by palpation outside the cystic cavity, but they are intimately connected with the cystic cavity.

The decisive diagnostic method is an ultrasound examination of the scrotum organs with measurement of the size of the cyst, testicles, and the ratio of the size of the spermatocele to the gonad.

Forms

A spermatocele is a cystic mass that usually develops in a man's testicle or epididymis (spermatic cord) and contains a fluid similar to sperm. Spermatoceles can come in a variety of shapes and sizes, including:

1. Simple spermatocele: This is the most common form, in which one or more small cysts form. It can be small and unnoticeable or larger.
2. Multiple spermatoceles: In rare cases, multiple cysts may develop in a testicle or epididymis.
3. Parenchymatous spermatocele: This form is characterized by changes in the testicular parenchyma, including an increase in the size and volume of the testicle itself.
4. Epididymal spermatocele: In this form, the spermatocele forms in the epididymis, a part of the male reproductive system.
5. Reverse spermatocele: This is a rare form in which a cyst forms near the back wall of the testicle.

Symptoms and severity of a spermatocele can vary depending on its size and location.

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Complications and consequences

In most cases, spermatoceles are benign and do not pose a serious health threat. However, complications and consequences may include:

1. Discomfort and pain: A large spermatocele or one that becomes more tense can cause discomfort, pressure, and pain in the testicle or epididymis area.
2. Impaired sperm count: Spermatoceles can affect sperm quality and lead to poor sperm count (sperm analysis) parameters. This may be important for men who are planning to become pregnant.
3. Infections: A spermatocele can become a source of infection, especially if the cyst becomes inflamed or infected.
4. Increased size and pressure on surrounding tissues: In some cases, a large spermatocele can cause the testicle or epididymis to increase in size and put pressure on blood vessels or other structures in the scrotal area.
5. Rare: Reproductive dysfunction: In rare cases, a large and long-term spermatocele may affect a man's reproductive functions.

Diagnostics spermatoceles

Spermatocele diagnostics includes a number of methods that allow one to determine the presence and nature of this cyst in the testicle or appendage. Here are the main methods of spermatocele diagnostics:

1. Physical examination: The doctor may begin the diagnosis by performing a physical examination of the scrotum and testicles. A spermatocele can usually be felt as a soft, fluid-filled mass in the epididymis.
2. Ultrasound (ultrasound): Ultrasound can visualize the spermatocele and determine its size, shape, and location. It is a reliable diagnostic method.
3. Spermogram: A semen analysis (sperm test) may be helpful, especially if the spermatocele is affecting the quality of the sperm. This test can help assess the impact of the spermatocele on fertility.
4. Magnetic resonance imaging (MRI): In some cases, an MRI may be performed to provide more detailed visualization of structures in the scrotum and testicles.
5. Computed tomography (CT): In rare cases, a CT scan may be performed to evaluate the spermatocele and its surrounding structures.
6. Differential diagnosis: Your doctor may also perform differential diagnosis to rule out other possible causes of a cyst in the scrotum, such as a hydrocele or epididymal cyst.

Differential diagnosis

Differential diagnosis of spermatocele involves identifying and distinguishing this condition from other medical conditions and masses in the scrotum and epididymis. Some possible differential diagnoses include:

1. Hydrocele: A hydrocele is a collection of fluid in the lining of the testicle. A hydrocele may look and feel similar to a spermatocele, but the fluid in a hydrocele does not contain sperm. Ultrasound can help differentiate between a spermatocele and a hydrocele.
2. Epididymitis: Epididymitis is an inflammation of the epididymis, part of the male reproductive system, which can lead to the formation of a cyst or tumor in the testicle area. Epididymitis is painful and may require antibiotic treatment.
3. Seminal stones (seminomas): Seminal stones are stones that form in the epididymis or spermatic cord and can cause discomfort and pain. They may be visible on ultrasound.
4. Epididymal sarcoma: This is a rare type of tumor that can develop in the epididymis and mimic spermatocele. Differentiation requires careful medical evaluation and biopsy.
5. Testicular hernia: A testicular hernia is a protrusion of abdominal contents through a weak spot in the abdominal wall muscles. It may be confused with a mass in the scrotum, but usually has other signs and symptoms, such as pain and visible increase with straining.

Treatment spermatoceles

Treatment of spermatocele is only surgical.

Indications for surgical treatment of cysts: spermatocele size over 5 mm, rapid growth of the cystic cavity.

In case of spermatocele, an operation is performed to enucleate the cyst followed by suturing the defect of the appendage.

Technique of the operation. A transverse incision is made in the skin along the anterior surface of the scrotum above the formation. The testicular membranes are dissected layer by layer. After the parietal leaf of the vaginal membrane is closed, the testicle and the cyst located at its upper pole are exposed and brought out into the wound.

The visceral layer of the vaginal membrane of the testicle is dissected over the cyst and it is enucleated to the base using blunt and sharp methods. The cyst is removed and its bed is sutured. The testicle is immersed in the scrotum and the membranes of the testicle are sutured layer by layer. A suspensory is applied, giving the scrotum an elevated position.

Prevention

Spermatoceles are benign conditions and in most cases cannot be prevented. However, there are general guidelines for maintaining the overall health of the male reproductive system and genitourinary organs that may help reduce the risk of developing any problems, including spermatoceles:

1. Proper scrotum and testicle care: Regularly washing the scrotum with water and mild soap can help keep the area hygienic and prevent irritation.
2. Avoiding injury and shock: Reducing the risk of injury to the scrotal area, such as during sports or other activities, can help prevent spermatoceles from developing.
3. Regular medical checkups: Regular visits to your doctor to examine your scrotum and epididymis can help identify any changes or abnormalities early.
4. Maintaining a healthy lifestyle: Eating a healthy diet, getting moderate physical activity, not smoking, and drinking alcohol in moderation help promote overall urinary tract health.
5. Using protection during sex: Using condoms and other methods of protection during sex can help prevent infections that can affect your urinary tract health.
6. Follow your doctor's advice: If you are already at risk for developing spermatoceles or other urinary tract problems, follow your doctor's advice and recommendations and have regular medical checkups.

Forecast

The prognosis is favorable; the treatment results are assessed dynamically using ultrasound.

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