Diagnostic Considerations

The differential diagnosis of spermatocele includes the following:

Hydrocele
Varicocele
Hernia
Simple epididymal cyst
Neoplasm

Workup

Rioja J, Sánchez-Margallo FM, Usón J, Rioja LA. Adult hydrocele and spermatocele. BJU Int. 2011 Jun. 107 (11):1852-64. [QxMD MEDLINE Link]. [Full Text].
Davis RS. Intratesticular spermatocele. Urology. 1998 May. 51(5A Suppl):167-9. [QxMD MEDLINE Link].
Rubenstein RA, Dogra VS, Seftel AD, Resnick MI. Benign intrascrotal lesions. J Urol. 2004 May. 171(5):1765-72. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Nash JR. Sclerotherapy for hydrocele and epididymal cysts: a five-year study. Br Med J (Clin Res Ed). 1984 Jun 2. 288(6431):1652. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Walsh TJ, Seeger KT, Turek PJ. Spermatoceles in adults: when does size matter?. Arch Androl. 2007 Nov-Dec. 53(6):345-8. [QxMD MEDLINE Link].
Salama N, Hassan OS. A Post-Aspiration Giant Spermatocele in a Young Man: A Case Report and Literature Review. Clin Med Insights Case Rep. 2022. 15:11795476221097218. [QxMD MEDLINE Link]. [Full Text].
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. [QxMD MEDLINE Link].
Sista AK, Filly RA. Color Doppler sonography in evaluation of spermatoceles: the "falling snow" sign. J Ultrasound Med. 2008 Jan. 27(1):141-3. [QxMD MEDLINE Link].
Gutman H, Golimbu M, Subramanyam BR. Diagnostic ultrasound of scrotum. Urology. 1986 Jan. 27(1):72-5. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Gebreselassie KH, Berhanu E, Akkasa SS, Woldehawariat BY. Torsed spermatocele, a rare cause of acute scrotum: Report of a case and review of literature. Urol Case Rep. 2022 Nov. 45:102172. [QxMD MEDLINE Link]. [Full Text].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Low LS, Nair SM, Davies AJW, Akapita T, Holmes MA. Aspiration and sclerotherapy of hydroceles and spermatoceles/epididymal cysts with 100% alcohol. ANZ J Surg. 2020 Jan. 90 (1-2):57-61. [QxMD MEDLINE Link].
Brockman S, Roadman D, Bajic P, Levine LA. Aspiration and Sclerotherapy: A Minimally Invasive Treatment for Hydroceles and Spermatoceles. Urology. 2022 Jun. 164:273-277. [QxMD MEDLINE Link].
Jahnson S, Rosell J, Aljabery F. Modulation of the inflammatory response after sclerotherapy for hydrocoele/spermatocoele. BJU Int. 2018 Sep 25. [QxMD MEDLINE Link].
Wegner R, Akwar D, Guzman-Reyes S, Pednekar G, Chaudhry R, Grewal N, et al. Evaluating the Adjuvant Effect of Dexamethasone to Ropivacaine in Transversus Abdominis Plane Block for Inguinal Hernia Repair and Spermatocelectomy: A Randomized Controlled Trial. Pain Physician. 2017 Jul. 20 (5):413-418. [QxMD MEDLINE Link]. [Full Text].

Media Gallery

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.

of 7

Author

Vernon M Pais, Jr, MD Associate Professor, Department of Surgery, Section of Urology, Geisel School of Medicine at Dartmouth

Vernon M Pais, Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Urological Association, Endourological Society, Sigma Xi, The Scientific Research Honor Society

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

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.

Chief Editor

Edward David Kim, MD, FACS Professor of Urology, Department 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 Society for Reproductive Medicine, American Urological Association, Sexual Medicine Society of North America, Society for Male Reproduction and Urology, Society for the Study of Male Reproduction, Tennessee Medical Association

Disclosure: Nothing to disclose.

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.

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.

Fluid Aspirated from Spermatocele (Volume in mL)	Sclerosant Solution Injected (Volume in mL)
< 20	2
20-50	3
51-100	5
101-200	10
201-300	15
301-400	20
401-800	25
>800	30

Spermatocele Differential Diagnoses

Diagnostic Considerations

References

Tables

Contributor Information and Disclosures

What would you like to print?