eMedicine Specialties > Urology > Common Problems of the Testicle

Spermatocele: Workup

Author: Vernon M Pais Jr, MD, Assistant Professor, Department of Surgery, Section of Urology, Dartmouth Medical School
Coauthor(s): Shaun E Wason, MD, Resident Physician, Department of Surgery, Division of Urology, Dartmouth-Hitchcock Medical Center
Contributor Information and Disclosures

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.

    A scrotal ultrasound demonstrating a spermatocele...

    A scrotal ultrasound demonstrating a spermatocele visible to the left of a normal testis.

    A scrotal ultrasound demonstrating a spermatocele...

    A scrotal ultrasound demonstrating a spermatocele visible to the left of a normal testis.

  • 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.

Microscopic view of spermatocele lined with cuboi...

Microscopic view of spermatocele lined with cuboidal epithelium.

Microscopic view of spermatocele lined with cuboi...

Microscopic view of spermatocele lined with cuboidal epithelium.

A gross specimen of a spermatocele is shown in Images 4 and 5.

Intraoperative view of spermatocele with adjacent...

Intraoperative view of spermatocele with adjacent testicle and spermatic cord.

Intraoperative view of spermatocele with adjacent...

Intraoperative view of spermatocele with adjacent testicle and spermatic cord.



Spermatocele after complete excision.

Spermatocele after complete excision.

Spermatocele after complete excision.

Spermatocele after complete excision.

More on Spermatocele

Overview: Spermatocele
Workup: Spermatocele
Treatment: Spermatocele
Follow-up: Spermatocele
Multimedia: Spermatocele
References

References

  1. Sista AK, Filly RA. Color Doppler sonography in evaluation of spermatoceles: the "falling snow" sign. J Ultrasound Med. Jan 2008;27(1):141-3. [Medline].

  2. 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].

  3. Davis RS. Intratesticular spermatocele. Urology. May 1998;51(5A Suppl):167-9. [Medline].

  4. 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].

  5. Gutman H, Golimbu M, Subramanyam BR. Diagnostic ultrasound of scrotum. Urology. Jan 1986;27(1):72-5. [Medline].

  6. Itoh M, Li XQ, Miyamoto K. Degeneration of the seminiferous epithelium with ageing is a cause of spermatoceles?. Int J Androl. Apr 1999;22(2):91-6. [Medline].

  7. 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].

  8. 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].

  9. 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].

  10. Rubenstein RA, Dogra VS, Seftel AD, Resnick MI. Benign intrascrotal lesions. J Urol. May 2004;171(5):1765-72. [Medline].

  11. 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].

  12. Walsh TJ, Seeger KT, Turek PJ. Spermatoceles in adults: when does size matter?. Arch Androl. Nov-Dec 2007;53(6):345-8. [Medline].

  13. 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

Contributor Information and Disclosures

Author

Vernon M Pais Jr, MD, Assistant Professor, Department of Surgery, Section of Urology, Dartmouth Medical School
Vernon M Pais Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Urological Association, Endourological Society, Sigma Xi, and Society of Laparoendoscopic Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Shaun E Wason, MD, Resident Physician, Department of Surgery, Division of Urology, Dartmouth-Hitchcock Medical Center
Shaun E Wason, MD is a member of the following medical societies: American Urological Association
Disclosure: Nothing to disclose.

Medical Editor

Allen Donald Seftel, MD, Professor, Department of Urology, Case School of Medicine
Allen Donald Seftel, MD is a member of the following medical societies: Ohio State Medical Association
Disclosure: lilly Consulting fee Consulting; sanofi-aventis Consulting fee Consulting; auxilium Consulting fee Consulting; solvay Consulting fee Consulting; plethora Grant/research funds clinical trial; indevus Consulting fee Consulting; nature publishing  journal editor

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Shlomo Raz, MD, Professor, Department of Surgery, Division of Urology, University of California at Los Angeles School of Medicine
Shlomo Raz, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, and California Medical Association
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting; Astellas Consulting fee Speaking and teaching; Indevus Consulting fee Speaking and teaching

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