AUA Summit - What are Spermatoceles (Spermatic Cysts)?

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What are Spermatoceles (Spermatic Cysts)?

Spermatoceles are also known as spermatic cysts. They are fluid-filled masses, often painless, and they grow near the testicles on the epididymis (tube that stores sperm). They tend to be benign (not cancerous). These cysts are found near the top and behind the testicle, but are separate from the testicle. They can be smooth, filled with a whitish, cloudy fluid and most often hold sperm. Their size can vary. If their size becomes a bother or causes pain, there are some ways to fix the problem. As a rule of thumb, they are not a serious medical issue.

The male reproductive tract handles the growth, maturation and delivery of sperm. Faults in the male reproductive tract can cause a mass to grow. If a mass forms in the scrotum, it may mean nothing, or it could be a sign of something serious. A set course of action is needed to learn the nature of the mass and the best treatment. For example, if the mass is testicular cancer, it is a source of great concern and requires action. Other masses, such as varicoceles, can cause pain or harm reproductive function. Spermatoceles are most often not cancerous, and do not increase your risk of testicular cancer, but they may be a nuisance.

Symptoms

Men with spermatoceles often have no symptoms. If there are signs, they may involve feeling a lump or heaviness on a self-exam in the scrotum, but not sharp pain.

Diagnosis

Spermatoceles are often found during a man's testicular self-exam, or by a doctor at a health exam. Self-exams should be done at least once a month. Your doctor can show you the right technique. If you note any suspicious changes, such as larger size or unusual firmness, you should call your doctor.

Light can be shined through a spermatocele. This generally shows if the mass looks like a solid tumor or a benign (not cancerous) cyst. Ultrasound (a test using sound waves to make images of organs) is a better way to check a cyst. This method is relatively quick, noninvasive and inexpensive.

Treatment

Since these cysts, as a rule of thumb, do not cause pain and are often not noticed, they rarely need treatment. The basic care for spermatoceles without pain is observation. But some men do have symptoms such as bothersome size or pain. When treatment is needed, there are many choices.

Medical Therapy

Oral pain or anti-swelling drugs may be used to ease pain caused by spermatoceles. No other type of medical therapy is needed. There is no drug to cure or prevent spermatoceles.

Minimally Invasive Therapies

Aspiration and sclerotherapy are two treatments that are available, but are not often used.

  • Aspiration involves puncturing the spermatocele with a needle and drawing out its contents.
  • Sclerotherapy involves injecting an irritating agent into the spermatocele sac. This causes it to heal or scar closed. This lowers the odds of fluid pooling again.

These options have been shown to work but, in general, they are not recommended and rarely used. There is a risk of harm to the epididymis, which can lead to fertility problems. Another common problem with both methods is that the spermatoceles can come back.

Surgical Therapy

Spermatocelectomy is the standard treatment for spermatoceles that cause symptoms. The goal of surgery is to remove the spermatocele from the epididymal tissue and preserve the reproductive tract. This outpatient procedure is often done with local or general anesthesia. It usually takes less than one hour. Sometimes all or a part of the epididymis may need to be removed as well.

After Treatment

You will likely be sent home with a pressure dressing like an athletic supporter filled with fluffy gauze. The support is worn for one to two weeks after surgery. Ice packs can be used for two to three days to help with swelling. Drugs for pain are often taken for one to two days after surgery. You can shower 48 hours after surgery.

A follow-up visit with your surgeon is often scheduled between one and three weeks later. Scrotal swelling is normal and typically lasts for 2 to 21 days. Side effects from surgery are not common, but can involve fever, infection, bleeding (scrotal hematoma) and lasting pain. Spermatoceles can come back in about 10 out of 25 cases. Blockage of the epididymis may also occur, which can lead to problems with fertility. For these reasons, surgery should be avoided in men who still want children. Talk to your doctor to find the best solution for you.

Updated March 2024.


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