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SPERMATOCOELE
Spermatocoele
Benign cystic accumulation of sperm
Arises from the head (caput)of the epididymis-on superior aspect.
Lesions are benign – retention cystsUsually uniclocularContain barley water like fluid-spermatozoa
Sites
Testicle- intrascrotal , paratesticular cystic
collections of sperm that arise from the epididymis.
Along the course of the vas deferens
Aetiology remains undefinedIn a mouse model - occluded by
agglutinated germ cells.Physical trauma, inflammation Epidydimal scarring obstruction
spermatocoele In utero exposure to diethylstilbestrol (DES)
Hypotheses- arise from efferent ductules, aneurysmal dilatations of the epididymis, dilatation secondary to distal obstruction
Clinical features
SymptomsTypically asymptomatic Incidental findings examinationUsually a painless mobile swelling
posterosuperiorly Associated symptoms scrotal heaviness
and dull discomfort
SignsSmooth and spherical FluctuantTransilluminate on examination
InvestigationUncomplicated asymptomatic
spermatocele no investigation neededIf scrotal pain urine analysis to rule
out epididymitis. FNAC-dead sperm
Ultrasonography Cystic lesions that arise from the epididymal
headLess 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.
Scrotal USS - spermatocele visible to the left of a normal testis.
Color Doppler -"falling snow" appearence (internal
echoes moving away from the transducer)Histologic Findings -fibromuscular wall that is lined by
cuboidal epithelium
Treatment Medical TherapyNo specific medical therapy . Oral analgesics If an underlying epididymitis -
antibiotics Observation is usually used for simple,
small asymptomatic spermatoceles.
Surgical Therapy
Spermatocelectomy The primary operative intervention Via a transscrotal approachRelative contraindications - Systemic anticoagulation -family incomplete
Performed on an outpatient basisWith either regional or general
anesthesia Complication-infertility, hematoma,
infection, swelling, recurrence, and pain.
SPAS(Spermatocele aspiration)high recurrence rate
Intraoperative view of spermatocele with adjacent testicle and spermatic cord
Spermatocele after complete excision
Sclerotherapy
Alternative to excisionLess effective.For men who have no desire for future
paternity Sclerosing agent coaptation cyst walls
Tetracycline, fibrin glue, phenol, sodium tetradecyl sulfate (STD)
A 65% success rate is quoted Complication
chemical epididymitis epididymal damage infertility
Bleeding, infection ,spermatocele
recurrence,scrotal wall thickness.
DDEpididymal cyst- multilocular, contain
clear fluid,brilliant transluminence is obtained
HydrocoeleVaricocoeleComplete inguinal
hernia
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