spermatoceles

Spermatoceles are benign cystic dilations of the epididymal ducts, typically located in the head of the epididymis. They contain fluid that may be milky and may include sperm, reflecting their origin from the epididymal duct system. They are regarded as a form of epididymal cyst and most often affect men of reproductive age.

Most spermatoceles are asymptomatic and discovered incidentally during a routine check or imaging. When they are noticeable, they present as a smooth, painless, mobile lump separate from the testicle. Larger spermatoceles can cause discomfort or a feeling of fullness in the scrotum. Transillumination is often positive, distinguishing them from solid masses. Differential diagnosis includes epididymal cysts, hydroceles, varicoceles, and testicular tumors.

Diagnosis is typically clinical plus imaging. A scrotal ultrasound is the preferred modality and shows a well-defined, cystic lesion in the epididymal head, usually without internal vascular flow. The cyst may appear anechoic or show internal echoes if debris is present. Ultrasound helps distinguish a spermatocele from other scrotal pathologies and guides management.

Management ranges from observation to surgical intervention. Asymptomatic spermatoceles generally require no treatment. Symptomatic or enlarging lesions, or those causing cosmetic concerns or discomfort, can be treated by surgical removal (spermatocelectomy). Percutaneous aspiration with or without sclerotherapy is less commonly used due to higher recurrence rates. Complications from surgery are uncommon but may include infection, recurrence, or injury to nearby structures.

The prognosis is favorable, with most spermatoceles remaining stable or being cured after appropriate treatment. They are not malignant and have a low risk of affecting fertility unless accompanied by other epididymal abnormalities.