Paediatrics Urology Unit
Prostate Growth And Greenlight Method
Premature Ejaculation (Early-Fast-Rapid Ejaculation)
Penile Prosthesis İmplantation
Sexually Transmitted Diseases (Venereal Diseases)
Testicle And Epididymis İnfection
• Assoc. Prof. Ömer ÖGE, MD
• Işık H. ÖZGÜ, MD
• Uğur SARAÇOĞLU, MD
What is spermatocele and how frequently it is seen?
Spermatocele is a formation in the bag shape containing a milky colour fluid material inside. Since it may contain sperm in fluid inside, it may be called as "spermatic cysts". It exhibits settlement in sperm carrying canal called "epididymis" adjacent to upper polar of testis separate from testis. IT can be detected in the rate up to 30 % in scrotal ultrasound applications conducted in adults.
What is the cause of spermatocele?
Formation cause in human is not known yet for certain. Its cause and formation mechanism have been investigated in only mice; it has been suggested that it has formed as a result of clogging of these canals with cells fitting inside of canals and deal sperm cells of sperm carrying canals removed from testis with the effect of ageing.
Symptoms of Spermatocele and Natural Course
Despite commonly seen, they may remain without exhibiting any symptom such as pain and inflammation for years due to the fact that relatively small sizes and cyst fluids exhibit antimicrobial feature. Cyst diameter is usually smaller than 1 – 2 cm. It can both remain in the same size without any growing and it may grow over time and it may rarely lead painful complaints and palpable mass in the bag. Cysts are benign and do not turn into cancer and its frequency increases with age. Sperm obtained from content of spermatocele detected in the persons not having a child (infertile) depending on male factor may be used in reproductive auxiliary treatment methods.
How Spermatocele is diagnosed?
It is generally diagnosed with slowly growing, painless mass story and physical examination. Patients sometimes may feel the mass by their hands on their own. In physical examination, spermatocele can be felt as a mobile and soft mass separate from testis and yields transillumination. (light transmission). Light transmittance is an indicator of that mass is filled with fluid. While it is seen as single, there may be cysts more than one. In addition to physical examination, it can be diagnosed with scrotal ultrasound examination. It is defined as cystic mass yielding posterior acoustic shading, properly contoured, hypoechoic, well-circumscribed features in ultrasound examination quickly performed and relatively less costly. There is no need for other diagnostic examinations, however, if there are suspicious findings ultrasonography examinations, magnetic resonance imaging analysis can be performed for placing a real diagnosis.
Treatment of Spermatocele Disease
Small spermatoceles or spermatoceles not causing any complaint are not needed to be treated. Painkiller medications can be administered to the patients with pain complaints but these medications do not remove cysts and this is a treatment intended for only reducing pain. Cysts causing complaints such as pain, cosmetic appearance disorder and palpable mass are recommended to be removed surgically. Diagnostic and therapeutic injection discharge and then administering medication inside cyst (sclerotherapy) is no use due to inflammation and recurrence risk in spermatocele treatment. Spermatocele is removed without damaging sperm carrying canals called epididymis and seminal duct with a surgical incision performed over the bag or groin with the operation. Micro-surgical methods are used for reducing complications relating to the operations (operation microscope, image enlarger special glasses). Operation can be applied under local, general and regional (spinal or epidural) anaesthesia.
Complications of Spermatocele Treatment
The most important complications of spermatocele treatment are hydrocele (collection of fluid around the testis), epididymis and seminal duct injury, edema on the operation area, redness and development of wound infection. Still, testis and veins feeding the testis may be damaged, this case may lead to testicular inflammation and testicular contraction. Blood clot may accumulate inside the bag. This case may lead to swelling and pain inside the bag. An additional surgical intervention may be required in case of development of complication. While recurrence of the disease may depend on incomplete removal of cyst and it may be seen as a result of grow of cysts over time in invisible microscopic size.
Also, there are some additional risks as to anesthesia type applied during operation. (general, regional, local). Allergies against local anaesthetic materials, high dose related convulsion, heart rhythm disorder, low blood pressure and loss of consciousness, numbness around mouth and tongue and tinnitus can be observed. Following spinal or epidural anesthesia, post back and headaches, temporary urinary incontinence, low blood pressure and drop in heart rhythm rate, respiratory failure, epidural or subdural hematoma, meningitis, neurologic and cardiac-circulatory system disorders may develop. In general anesthesia applied cases, airway damages (teeth, mandible, larynx and vocal cords), air embolism, disorders of eye (corneal scratches, optic neuritis) and a heart-circulatory system disorders can be observed.
Lungs and wounds inflammation risk, cardiac and lung complications and thrombosis risks have increased in the overweight persons with smoking habit and with uncontrolled diabetes.
Treatment and intervention may be applied depending on the complications mentioned hereinabove.
Duration of Surgical Intervention, Hospitalization Stay Time
The surgery may be performed in the manner that the patient arrives at hospital on the operation day and returns home on the same day after a particular time and the patient may spend one night at hospital and can be discharge on the following day due to the changes depending on progress of the surgery and anesthesia. Spermatocele treatment may vary depending on the person and patient to whom the procedure is applied and this is around 30-45 minutes in one sided disease and around 45-60 minutes in case of disease in both sides. The extracted material may be subject to pathological evaluation if deemed necessary by the physician.
What are the results of spermatocele treatment?
The success rates in the surgeries no complication development and performed under non-urgent conditions (complete removal of cyst in the bag) is over 90 %. Long term infertility problems may arise in men developing complication following operation and not having a child or desiring to have a child in the future.
What are the issues to be considered after the treatment?
Daily chores can be generally done after 1 day resting at home following spermatocele operation. Since stitching material absorbed by the body for skin is used, stitches generally melt after approximately seven days; therefore, removing stitches is not required and at the end of this period, you can have a bath. The patient is usually worn with suspensory pant for lifting and supporting upwardly the bag after operation and it is recommended that this pant is continuously worn minimum one week. Generally in post-operative case, one week protective antibiotic, analgesic-anti-inflammatory medication treatment is administered for pain and inflammation and it is recommended for the patient to use them orally. After approximately two weeks sexual intercourse activation is allowed and heavy work life and sport activities after four weeks are allowed. It is recommended to visit the physician in terms of check of wound recovery and inflammation following 7-10 days after operation and for general check after 3 months. There is no routine monitoring after treatment thereafter.