SPERMATOCELE (AKA EPIDIDYMAL CYST):
Dear Sumner:
George, a 23 year old man, called me last week in a panic that he had found an extra testicle in his scrotum. When I examined him, I found a mass above and separate from his left testicle which seemed to be softer than the testis. I think that the mass represents a spermatocele although George would like to be certain that he doesn’t have a tumor. Assuming that it is, indeed, a spermatocele, can the fluid within it be aspirated and its lining destroyed with some type of chemical solution, or must the entire mass be removed. If nothing is done, might it affect his fertility? He will be calling you for an appointment in the near future.
Dear Felicia:
George was still quite anxious about the mass in his scrotum when I saw him in the office today. The fact that the mass transilluminated and was separate from the testis itself is consistent with the diagnosis of a spermatocele. A spermatocele is usually thought to arise from obstruction of an epididymal duct, with the secondary dilatation forming a cystic structure. Smaller spermatoceles are sometimes referred to as epididymal cysts. However, we did discuss what procedures might be considered if there was associated discomfort due to a significant increase in its size, as well as the potential risks of invasive therapy. In the case of a spermatocele, my own feeling is that active treatment may cause more problems than surveillance only. For example, not only might reaccumulation of the fluid occur after needle aspiration of a spermatocele, but the procedure itself runs a risk of infection. Even more importantly, epididymal obstruction can result from both the surgery as well as from the chemical destruction of its lining (sclerotherapy)--which obviously could adversely affect his fertility.
