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Spermatocele Workup

  • Author: Vernon M Pais, Jr, MD; Chief Editor: Edward David Kim, MD, FACS  more...
 
Updated: Oct 15, 2015
 

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.

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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 the image below.

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]

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Histologic Findings

Microscopic examination reveals a fibromuscular wall that is lined by cuboidal epithelium, as illustrated in the image below.

Microscopic view of spermatocele lined with cuboidMicroscopic view of spermatocele lined with cuboidal epithelium.

A gross specimen of a spermatocele is shown in the images below.

Intraoperative view of spermatocele with adjacent Intraoperative view of spermatocele with adjacent testicle and spermatic cord.
Spermatocele after complete excision. Spermatocele after complete excision.
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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, 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.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Shlomo Raz, MD Professor, Department of Surgery, Division of Urology, University of California, Los Angeles, David Geffen School of Medicine

Shlomo Raz, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, California Medical Association

Disclosure: Nothing to disclose.

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, Tennessee Medical Association, Sexual Medicine Society of North America, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Repros.

Additional Contributors

Allen Donald Seftel, MD Professor of Urology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School; Head, Division of Urology, Director, Urology Residency Training Program, Cooper University Hospital

Allen Donald Seftel, MD is a member of the following medical societies: American Urological Association

Disclosure: Received consulting fee from lilly for consulting; Received consulting fee from abbott for consulting; Received consulting fee from auxilium for consulting; Received consulting fee from actient for consulting; Received honoraria from journal of urology for board membership; Received consulting fee from endo for consulting.

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

  2. Jahnson S, Sandblom D, Holmäng S. A randomized trial comparing 2 doses of polidocanol sclerotherapy for hydrocele or spermatocele. J Urol. 2011 Oct. 186(4):1319-23. [Medline].

  3. East JM, DuQuesnay D. Sclerotherapy of idiopathic hydroceles and epididymal cysts: a historical comparison trial of 5% phenol versus tetracycline. West Indian Med J. 2007 Dec. 56(6):520-5. [Medline].

  4. Kauffman EC, Kim HH, Tanrikut C, Goldstein M. Microsurgical spermatocelectomy: technique and outcomes of a novel surgical approach. J Urol. 2011 Jan. 185(1):238-42. [Medline].

  5. Shan CJ, Lucon AM, Pagani R, Srougi M. Sclerotherapy of hydroceles and spermatoceles with alcohol: results and effects on the semen analysis. Int Braz J Urol. 2011 May-Jun. 37(3):307-12; discussion 312-33. [Medline].

  6. Shah VS, Nepple KG, Lee DK. Routine pathology evaluation of hydrocele and spermatocele specimens is associated with significant costs and no identifiable benefit. J Urol. 2014 Oct. 192 (4):1179-82. [Medline].

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

  8. Gray CL, Powell CR, Amling CL. Outcomes for surgical management of orchalgia in patients with identifiable intrascrotal lesions. Eur Urol. 2001 Apr. 39(4):455-9. [Medline].

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

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

  11. Moloney GE. Comparison of results of treatment of hydrocele and epididymal cysts by surgery and injection. Br Med J. 1975 Aug 23. 3(5981):478-9. [Medline].

  12. Nash JR. Sclerotherapy for hydrocele and epididymal cysts: a five-year study. Br Med J (Clin Res Ed). 1984 Jun 2. 288(6431):1652. [Medline].

  13. Nashan D, Behre HM, Grunert JH. Diagnostic value of scrotal sonography in infertile men: report on 658 cases. Andrologia. 1990 Sep-Oct. 22(5):387-95. [Medline].

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

  15. Tammela TL, Hellstrom PA, Mattila SI. Ethanolamine oleate sclerotherapy for hydroceles and spermatoceles: a survey of 158 patients with ultrasound followup. J Urol. 1992 Jun. 147(6):1551-3. [Medline].

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

  17. Zahalsky MP, Berman AJ, Nagler HM. Evaluating the risk of epididymal injury during hydrocelectomy and spermatocelectomy. J Urol. 2004 Jun. 171(6 Pt 1):2291-2. [Medline].

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A sagittal section of the testicle. Idiopathic obstruction of the epididymal ducts is one hypothesis that explains the formation of spermatoceles.
Diagram of a spermatocele.
Spermatocele as seen prior to incision.
Intraoperative view of spermatocele with adjacent testicle and spermatic cord.
Spermatocele after complete excision.
A scrotal ultrasound demonstrating a spermatocele visible to the left of a normal testis.
Microscopic view of spermatocele lined with cuboidal epithelium.
Table 1. Volume of Sclerosant Solution Used for Sclerotherapy
Fluid Aspirated from Spermatocele



(Volume in mL)



Sclerosant Solution Injected



(Volume in mL)



< 202
20-503
51-1005
101-20010
201-30015
301-40020
401-80025
>80030
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