spermatocele

A spermatocele is a benign, fluid-filled cyst that arises from the epididymal duct in the scrotum. It typically contains clear or milky fluid and sperm, and it is usually located at the upper pole of the testis, separate from the testicle itself.

Most spermatoceles are asymptomatic. They present as a painless, soft, round or dome-shaped mass in the scrotum, often detected during routine examination or self-check. The swelling may be transferable in size and can cause a feeling of heaviness if large. The scrotal skin generally remains of normal color, and the testis is usually easy to distinguish from the cyst.

Pathophysiology is not fully understood, but spermatoceles are thought to result from dilation of the epididymal ducts, possibly due to obstruction or congenital remnants. The ejaculatory function remains unaffected in most cases.

Diagnosis is typically based on physical examination. Transillumination of the scrotum can help distinguish cystic from solid masses. Ultrasound is commonly used to confirm the diagnosis and to exclude other conditions such as testicular tumors, hydroceles, varicoceles, or epididymal cysts. If needed, Doppler ultrasound can assess blood flow and rule out competing diagnoses.

Management is usually conservative. Asymptomatic spermatoceles are monitored. Symptomatic, enlarging, or uncertain lesions may be treated with surgical removal of the cyst (often via a microsurgical approach to preserve nearby structures) or, less commonly, aspiration with or without sclerosant. Recurrence or complications are uncommon but can occur.

Prognosis is generally excellent, with benign behavior. Spermatoceles do not typically affect fertility, though surgical treatment carries a small risk to nearby reproductive structures.