eMedicine Specialties > Urology > Common Problems of the Testicle
Spermatocele: Workup
Updated: Jun 26, 2009
Workup
Laboratory Studies
- No laboratory studies are mandated in the evaluation of an uncomplicated asymptomatic spermatocele. If the patient reports scrotal pain, a urinalysis is indicated to rule out epididymitis.
Imaging Studies
- The preferred modality for evaluating scrotal pathology is high-resolution scrotal ultrasonography. Although many experienced physicians may be comfortable making the diagnosis based on history and physical examination, ultrasonography is useful to confirm the suspected diagnosis and to rule out any additional intratesticular pathologic condition.
- Spermatoceles usually appear as cystic lesions that arise from the epididymal head; less commonly, they appear as an intratesticular lesion attached to the mediastinum testis. They are hypoechoic with posterior acoustic enhancement and usually cannot be differentiated from an epididymal cyst based on ultrasonographic findings. Occasionally, a spermatocele may have internal echoes within the cyst. An example of a spermatocele observed on scrotal ultrasonography is shown in Image 6.
- Color Doppler may reveal a "falling snow," resulting from internal echoes moving away from the transducer.1
Histologic Findings
Microscopic examination reveals a fibromuscular wall that is lined by cuboidal epithelium, as illustrated in Image 7.
A gross specimen of a spermatocele is shown in Images 4 and 5.
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Workup: Spermatocele |
| Treatment: Spermatocele |
| Follow-up: Spermatocele |
| Multimedia: Spermatocele |
| References |
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References
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East JM, DuQuesnay D. Sclerotherapy of idiopathic hydroceles and epididymal cysts: a historical comparison trial of 5% phenol versus tetracycline. West Indian Med J. Dec 2007;56(6):520-5. [Medline].
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Gray CL, Powell CR, Amling CL. Outcomes for surgical management of orchalgia in patients with identifiable intrascrotal lesions. Eur Urol. Apr 2001;39(4):455-9. [Medline].
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Moloney GE. Comparison of results of treatment of hydrocele and epididymal cysts by surgery and injection. Br Med J. Aug 23 1975;3(5981):478-9. [Medline].
Nash JR. Sclerotherapy for hydrocele and epididymal cysts: a five-year study. Br Med J (Clin Res Ed). Jun 2 1984;288(6431):1652. [Medline].
Nashan D, Behre HM, Grunert JH. Diagnostic value of scrotal sonography in infertile men: report on 658 cases. Andrologia. Sep-Oct 1990;22(5):387-95. [Medline].
Rubenstein RA, Dogra VS, Seftel AD, Resnick MI. Benign intrascrotal lesions. J Urol. May 2004;171(5):1765-72. [Medline].
Tammela TL, Hellstrom PA, Mattila SI. Ethanolamine oleate sclerotherapy for hydroceles and spermatoceles: a survey of 158 patients with ultrasound followup. J Urol. Jun 1992;147(6):1551-3. [Medline].
Walsh TJ, Seeger KT, Turek PJ. Spermatoceles in adults: when does size matter?. Arch Androl. Nov-Dec 2007;53(6):345-8. [Medline].
Zahalsky MP, Berman AJ, Nagler HM. Evaluating the risk of epididymal injury during hydrocelectomy and spermatocelectomy. J Urol. Jun 2004;171(6 Pt 1):2291-2. [Medline].
Further Reading
Keywords
spermatocele, epididymal cyst, scrotal mass, hydroceles, varicoceles, epididymis, testis, testicle, epididymitis, spermatocelectomy, sclerotherapy, scrotum, benign cystic accumulation of sperm, epididymal ductal obstruction, cystic segmental dilatation of epididymis, chemical epididymitis








Workup: Spermatocele