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Spermatocele

Spermatocele -Causes, Diagnosis and its Treatment

 

Introduction

Spermatocele is a fluid-filled cystic formation on the Epididymis. Epididymis is a small tube which is on top of the testicles and is responsible for transport of semen to penis. The cyst formation in spermatocele happens because of obstructions in the Epididymis passage. Due to this obstruction, the spermatozoa get trapped in this cyst and over time become inactive, but remain suspended in a fluid state. A spermatocele generally is located on top of the testis or behind the testis. These may remain static or grow in size and are filled with a cloudy, whitish fluid. Although spermatocele are not known to be inherently harmful, they are known to cause discomfort and shape distortion in advanced cases of the condition.

Risk Factors

Spermatocele condition in itself is quite harmless and doesn’t have any pathological effect on the patient’s lifestyle. However, if allowed to grow at an unchecked rate, spermatocele can grow to a large and uncomfortable size. They may also result in swelling and redness on effected area of scrotum which can be quite painful. If the spermatocele is positioned above the testis, it can also lead to weighing down or continual pressure on the penis. This in turn can make intercourse very difficult and painful for the person suffering from spermatocele. With patients suffering from recurrent spermatocele conditions, at times carcinogenic growth can be mistaken for a spermatocele cyst by the patient, thereby making early diagnosis impossible. This condition is most commonly found in men between the ages of 20 – 50 years.

Causes

It is estimated that spermatocele is not a rare condition, and about 30% of male population suffer from it. Although large spermatocele are much rarer, they can and do exist, causing pain as well as discomfort in patients. The epididymis, which is the affected area by spermatocele cysts, has multiple tubes which transport sperms from testis to penis. Primary causes of spermatocele are difficult to substantiate and are not clearly identified. However, certain conditions are known to cause spermatocele in epididymis tubes-

  • Intra-tubular obstruction: The efferent duct or tubes in epididymis transport sperms from testis to penis on an ongoing basis, once a man reaches puberty. This consistent flow of sperms through ducts can result in increase in tubular size and consequential obstructions. These obstructions can start storing small quantities of spermatic fluids and develop in cysts.
  • Inflammation or trauma: Although these conditions are not mandatory for development of spermatocele, severe or repetitive trauma to the epididymis can damage the internal tubes and cause scarring. This in turn can lead to development of spermatocele.
  • Exposure to DiEthylStilbestrol: DES of DiEthylStilbestrol is a synthetic form of estrogen. If a fetus is exposed to DES in utero, the chance of obstruction in epididymis tubes increases substantially. As spermatocele condition aggravates with age, DES exposure becomes apparent at a later age only.

Diagnosis

As spermatocele cysts rarely manifest any visible symptoms, the diagnosis can happen only if the patient is subject to a genital area check-up for alternate reasons or identifies visible projections on the testicle surface. Therefore, primary diagnostic measures include physical inspection. The physical inspection is also done to ensure that the cystic formations are spermatocele and not cancerous in nature.

  • Trans-illumination: In this form of diagnosis, light is directed at the cystic formation. If, the cyst is filled with fluids with inactive spermatozoa; the light simply passes through the cyst. If the cyst is, however, filled of solid bodies such as cancerous cells; the light will be absorbed by the surface. This method can easily indicate whether a cyst is merely spermatocele filled with fluid or cancerous in nature.
  • Ultra-sonography: Upon positive inspection and positive confirmation from trans-illumination examination; next level of diagnosis can be ultrasonography (USG). The technique reveals the size and complexity of cyst. Ultrasound can also reveal if multiple cysts exist over a single testis. Depending upon the severity of the condition, further treatment option can then be suggested by the consulting urologist.

Treatment for Spermatocele

The most commonly adopted treatment for getting rid of spermatoceles is surgical and is preferred only when spermatoceles keep increasing in size, become inflamed and painful as well as obstruct blood supply to the penis. This surgery is known as Spermatocelectomy and can be performed by a trained urologist to remove the spermatocele cysts from the scrotum.  This surgery is performed under local anesthetic and is a simple out-patient procedure. Although spermatocele doesn’t cause infertility; for an existing infertility issue, spermatocelectomy can’t restore fertility. Recurrence of spermatocele is a rare condition but can happen in some patients even after surgical removal.