Spermatocele

Diagnosis

To diagnose a spermatocele, a physical exam is usually the first step. Although a spermatocele typically isn’t painful, you may feel some discomfort when the doctor examines, or palpates, the mass in the scrotum.

Additional diagnostic tests may be recommended to confirm the diagnosis:

• Transillumination. A light is shined through the scrotum. If the mass is a spermatocele, the light passes through, showing that it is fluid-filled rather than solid.

• Ultrasound. If transillumination does not clearly identify the mass as a cyst, an ultrasound may be done. This test uses high-frequency sound waves to create images of the scrotal structures and helps rule out conditions such as a testicular tumor or other causes of scrotal swelling.

Treatment

In many cases, a spermatocele does not go away on its own but also does not require treatment. Most spermatoceles cause no pain or complications. If discomfort is present, your doctor may suggest over-the-counter pain relievers such as acetaminophen or ibuprofen.

Surgical treatment

When symptoms are significant, a surgical procedure called a spermatocelectomy may be recommended. This is usually done on an outpatient basis using local or general anesthesia. During the procedure, the surgeon makes an incision in the scrotum and carefully separates the spermatocele from the epididymis.

After surgery, your doctor may advise you to:

• Wear a gauze-filled athletic supporter to support and protect the surgical area

• Apply ice packs for two to three days to reduce swelling

• Take oral pain medications for a short time, usually one to two days

• Return for a follow-up visit within one to three weeks after surgery

Possible complications of surgery include damage to the epididymis or the vas deferens, which can affect fertility. There is also a possibility that the spermatocele may return even after surgery.

Aspiration with or without sclerotherapy

Aspiration and sclerotherapy are alternative treatments, though they are rarely used. Aspiration involves inserting a needle into the spermatocele and removing the fluid.

If the spermatocele comes back, aspiration may be repeated, followed by injecting a chemical into the sac. This process, called sclerotherapy, causes scarring that reduces space for fluid to collect and lowers the chance of recurrence. However, sclerotherapy can damage the epididymis, and the spermatocele may still return.

Protecting fertility

Both surgery and sclerotherapy carry a risk of damaging the epididymis or vas deferens, which can affect fertility. Because of this, treatment may be postponed until you are finished having children. If discomfort is severe and treatment cannot be delayed, discuss the risks, benefits, and the option of sperm banking with your doctor.