Spermatocele is a cavity formation of a testicle or its appendage, limited by a fibrous membrane and containing seminal fluid, spermatocytes and spermatozoa. Due to its small size and slow growth, it usually proceeds asymptomatically, in rare cases there is pressure and painful sensations in the scrotum. The main diagnostic methods are examination and palpation of the scrotum by a urologist, ultrasound and diaphanoscopy. Treatment for large cyst sizes may include surgical excision, fine needle aspiration, sclerotherapy.
Spermatocele (seminal cyst) is formed due to a violation of the normal outflow of secretions from the appendage of the testicle and its accumulation in the excretory duct with the formation of a pathological cavity in the area of the head or tail of the appendage and the spermatic cord. The contents can be represented by a transparent or milk-like secret, which includes seminal fluid, seminal cells, spermatozoa, fat cells, epithelial cells and single leukocytes. Pathology can be congenital and acquired, its share in clinical andrology accounts for about 7% of scrotal diseases. The pathology is benign in nature, often manifests itself during the period of active changes in the genital glands (6-14 years, 40-50 years).
The formation of a congenital formation occurs from the embryonic rudiments of the Muller ducts (hydatids) and is associated with partial non-infection of the vaginal process of the peritoneum, in which non-communicating cavities remain along the course of the appendage of the testicle and the spermatic cord.
In the case of acquired spermatocele, damage to the excretory seminal ducts occurs due to injury or inflammatory diseases of the scrotum (vesiculitis, orchitis, epididymitis, deferentitis). Injured or inflammatory-altered ducts cease to function due to obstruction. There is no excretion of the seminal secretion, it overflows the duct, stretching its walls and forming a cyst.
The congenital variant of the pathology usually has a small size (2-2.5 cm) and contains a transparent light yellow liquid without admixture of spermatozoa. Acquired formations can be single- and multi-chamber, with different contents: thick, milky or transparent opalescent, with an admixture of spermatozoa and seminal cells.
Often the cyst is asymptomatic and slowly increasing in size, does not cause disorders of sexual and reproductive function in men. You can accidentally feel a painless spherical formation in the upper part of the scrotum. When reaching large sizes, patients complain of an increase in the size of the scrotum, discomfort, heaviness and pain during movement, walking, sitting, sexual intercourse. Possible complications include rupture and suppuration of the seminal cyst.
A visual examination of the scrotum can detect the contours of a large spermatocele; palpation allows you to feel a painless elastic formation located above the testicle and isolated from it. Instrumental diagnostic methods in most cases make it possible to quickly and easily diagnose this condition:
- Diaphanoscopy. It is used to recognize the nature of the formations of the scrotum by its transmission by rays of passing light. The glow of the scrotum with red light shows that the light passes completely through the tissues and the existing formation is filled with liquid. Unlike tumors of the testicle and its appendage, the spermatocele freely transmits light.
- Ultrasound of the scrotum. Allows the most accurate diagnosis of pathology. Based on the results of ultrasound, it is possible to determine the location of the seminal cyst and estimate its size. Echoscopically, a spermatocele is defined as a homogeneous formation having a thin wall with smooth and clear contours.
For differential diagnosis with tumor processes, magnetic resonance imaging or computed tomography is sometimes additionally performed. Differential diagnosis is performed with testicular and appendage cancer, testicular dermoid cyst and hydrocele.
With an asymptomatic course and an insignificant cyst size, special treatment is not required, a wait-and-see tactic is used. With an increase in the scrotum, causing discomfort and pain due to deformation of the surrounding tissues, it is necessary to excise the cyst of the epididymis surgically. Analgesics and anti-inflammatory drugs are used as drug therapy to relieve pain and discomfort. Surgical treatment may include:
Removal of the cyst of the epididymis (spermatocelectomy). The operation is performed on an outpatient basis under local anesthesia. Surgical intervention is performed under optical magnification through a small incision of the skin on the anterior surface of the scrotum in the area above the testicle. The cyst is exfoliated, leaving the unchanged tissue of the testicle and its appendage unaffected. A mandatory morphological examination of the contents is carried out. After spermatocelectomy, a suspension is applied to the patient for 2 or more days to maintain the scrotum. It is recommended to apply ice during the first days to eliminate swelling and prevent hematomas.
Needle aspiration and sclerotherapy. Less often palliative methods are used for treatment. Aspiration of the spermatocele is carried out by puncturing the most prominent part of the scrotum with a special hollow needle, if necessary, under the control of ultrasound. In sclerotherapy, after removing the liquid contents of the cyst, a special solution (sclerosant) is injected directly into the cavity of the formation, followed by massage of the scrotum for a more uniform distribution of the drug. Sclerotherapy helps to glue the walls of the spermatocele and stop the accumulation of fluid in it.
Within a month after the intervention on the scrotum, observation by an andrologist is indicated.
Prognosis and prevention
The prognosis after spermatocelectomy is usually favorable: the visible cosmetic defect gradually disappears, the impaired reproductive function is restored. Rarely, after surgical interventions on the scrotum, bleeding, testicular dropsy, pronounced scarring, obstruction of the vas deferens and infertility are possible (with damage to the vas deferens or vessels of the testicle that disrupt the processes of maturation and sperm transport). In addition, after aspiration and sclerotherapy, a relapse of the disease is not excluded, therefore these methods are used only in men of reproductive age.
If a recurrence of the spermatocele is suspected, a diagnostic ultrasound of the scrotum must be performed. With a bilateral lesion of the appendages of the testicle and a sufficiently rapid growth, the cyst can squeeze the normally functioning ducts and lead to infertility. For prevention, injuries and inflammation of the scrotum organs should be avoided, self-examination should be carried out regularly and specialists should be contacted in a timely manner if additional formations are detected.