Cystic structures arising from epididymal tubules, rete testis, or efferent ductules. Hypothesis that epididymal ducts are obstructed distally, causing a proximal dilatation.
Usually idiopathic, although proposed aetiologies include trauma or inflammatory reaction.
Spermatocele is an epididymal cyst containing spermatozoa or seminal fluid.
Usually painless mass within scrotum – often felt separate to the testis itself (classically above and behind), and with distinct borders.
Surgery indicated based on level of patients bother. Needle aspiration tends to recur.
If operating for pain – be aware pain may not resolve. Other risks include haematoma, recurrence, infection, post-operative pain, and potential obstructive azoospermia.
Trans-scrotal approach with opening of the tunica vaginalis to expose testis and epididymis.
- Dissection of the cyst to its wall – should be no vessels covering (cf. hydrocele).
- Dissection to small stalk – ligate with absorbable suture
- Sometimes very inflamed or adhesions – oversew or cauterise remaining sac wall
- Rarely, due to significant inflammation, epididymectomy (total or partial) may be necessary