Spermatocoele
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Spermatocoele
- 3. Spermatocoele Benign cystic accumulation of sperm Arises from the head (caput)of the epididymis-on superior aspect. Lesions are benign – retention cysts Usually uniclocular Contain barley water like fluid- spermatozoa
- 4. Sites Testicle- intrascrotal , paratesticular cystic collections of sperm that arise from the epididymis. Along the course of the vas deferens
- 5. Aetiology remains undefined In a mouse model - occluded by agglutinated germ cells. Physical trauma, inflammation Epidydimal scarring obstruction spermatocoele In utero exposure to diethylstilbestrol (DES)
- 6. Hypotheses- arise from efferent ductules, aneurysmal dilatations of the epididymis, dilatation secondary to distal obstruction
- 7. Clinical features Symptoms Typically asymptomatic Incidental findings examination Usually a painless mobile swelling posterosuperiorly Associated symptoms scrotal heaviness and dull discomfort
- 8. Signs Smooth and spherical Fluctuant Transilluminate on examination
- 9. Investigation Uncomplicated asymptomatic spermatocele no investigation needed If scrotal pain urine analysis to rule out epididymitis. FNAC-dead sperm
- 10. Ultrasonography Cystic lesions that arise from the epididymal head Less commonly- intratesticular lesion attached to the mediastinum testis. Hypoechoic with posterior acoustic enhancement and cannot be differentiated from an epididymal cyst . Occasionally, may have internal echoes within the cyst.
- 11. Scrotal USS - spermatocele visible to the left of a normal testis.
- 13. Color Doppler -"falling snow" appearence (internal echoes moving away from the transducer) Histologic Findings -fibromuscular wall that is lined by cuboidal epithelium
- 15. Treatment Medical Therapy No specific medical therapy . Oral analgesics If an underlying epididymitis - antibiotics Observation is usually used for simple, small asymptomatic spermatoceles.
- 16. Surgical Therapy Spermatocelectomy The primary operative intervention Via a transscrotal approach Relative contraindications - Systemic anticoagulation -family incomplete
- 17. Performed on an outpatient basis With either regional or general anesthesia Complication- infertility, hematoma, infection, swelling, recurrence, and pain. SPAS(Spermatocele aspiration) high recurrence rate
- 18. Intraoperative view of spermatocele with adjacent testicle and spermatic cord Spermatocele after complete excision
- 19. Sclerotherapy Alternative to excision Less effective. For men who have no desire for future paternity Sclerosing agent coaptation cyst walls Tetracycline, fibrin glue, phenol, sodium tetradecyl sulfate (STD)
- 20. A 65% success rate is quoted Complication chemical epididymitis epididymal damage infertility Bleeding, infection ,spermatocele recurrence,scrotal wall thickness.
- 21. DD Epididymal cyst- multilocular, contain clear fluid,brilliant transluminence is obtained Hydrocoele Varicocoele Complete inguinal hernia