Spermatocele is defined as a painless, sperm-containing mass in the caput of the epididymis. They generally occur in middle-aged men and are never seen in children. This lesion is generally not painful and is palpable above the testicle, which is usually palpable. They
can reach a massive size and extend up to the external ring. A not uncommon presentation is to have the patient come to the office complaining of the feeling of having a third testicle. Spermatoceles can be thought of diverticula of the epididymal tubules. The can be uni-or multiloculated and contain a mixture of sperm and sloughed epithelium. Importantly, these do not obstruct sperm transport. Most spermatoceles are idio-pathic but some have a history of trauma. There appears to be no relation to vasectomy.
On questioning, patients will report a painless scrotal mass that was discovered during self-examination. On exam, the mass does not change in size with position or Valsalva. Ultrasound is diagnostic if the physical exam is equivocal and should certainly be done if any testicular pathology is suspected.
Treatment of the spermatocele should be based upon symptoms as well as patient age. A risk factor for spermatocelectomy in patients who wish to father children is that there maybe complete epididymal obstruction if the delicate epididymal tubule is damaged. However, if patients are significantly bothered by the sper-matocele, then repair should be offered. A microsurgical approach has the best chance of avoiding epididy-mal damage. Additionally, small cysts can be seen with the microscope. Huge spermatoceles can sometimes obscure the vas deferens and the testicular artery. Both of these structures should be dissected and preserved by directing attention to the area cephalad to the lesion.
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