A spermatocele is a common, typically benign, fluid-filled sac that forms near the testicle. While most spermatoceles do not require intervention, they can prompt a search for removal options. Most are not medically harmful and are only removed if they become bothersome or symptomatic.
Understanding What a Spermatocele Is
A spermatocele, also known as a spermatic cyst, is a cystic structure that develops specifically in the epididymis. The epididymis is the tightly coiled tube located on the upper and back side of the testicle that stores and transports sperm. This benign mass is an out-pouching from the epididymis and is separate from the testicle itself.
The cyst is filled with clear or milky fluid and may contain sperm. Spermatoceles are thought to arise from a blockage in one of the small tubules that transport sperm from the testicle into the epididymis. Diagnosis typically begins with a physical examination, where a doctor may use transillumination—shining a light through the scrotum—to confirm the mass is fluid-filled. An ultrasound may also be used to rule out other causes of scrotal swelling, such as a testicular tumor.
When Treatment is Necessary
Most spermatoceles are asymptomatic and remain stable in size, meaning they rarely cause problems and do not require treatment. For many men, the standard approach is “watchful waiting,” which involves monitoring the mass for any changes during routine physical examinations. This is because the condition is non-cancerous and does not typically affect fertility or sexual function.
Intervention is generally reserved for cases where the spermatocele grows large enough to cause significant symptoms or distress. Criteria for removal include chronic pain or discomfort in the affected testicle or a persistent feeling of heaviness. Treatment may also be recommended if the cyst’s size causes pressure, interferes with daily activities, or results in a substantial enlargement of the scrotum. The decision to move past observation is weighed against the potential risks of the removal procedures themselves.
Medical Procedures to Remove a Spermatocele
When a spermatocele requires removal due to symptoms, two main procedures are used to eliminate the mass. The most common and definitive method is a surgical operation called a spermatocelectomy. This procedure is usually performed on an outpatient basis using local, regional, or general anesthesia.
During a spermatocelectomy, the surgeon makes a small incision in the scrotum to access the mass. The goal is to carefully dissect and separate the spermatocele from the epididymis while preserving the surrounding structures. Although the procedure is highly effective, a portion of the epididymis may need to be removed to ensure complete excision of the cyst.
A less common, minimally invasive option is aspiration followed by sclerotherapy. Aspiration involves inserting a needle into the cyst and draining the fluid, but this is rarely done alone because the fluid has a high tendency to re-accumulate. Sclerotherapy addresses recurrence by injecting a chemical agent, such as doxycycline or alcohol, into the empty cyst sack immediately after aspiration. This injected agent irritates the sac walls, causing them to scar and close, which eliminates the space where fluid could collect again and lowers the risk of recurrence.
Recovery and Potential Side Effects
Recovery from spermatocele removal depends on the procedure performed, but both require a period of rest and monitoring. Following a spermatocelectomy, patients are advised to use ice packs for the first couple of days to manage swelling and take oral pain medication as needed. Swelling and bruising in the scrotum are normal and can persist for a few days to a couple of weeks.
Activity restrictions are in place for several weeks, requiring avoidance of heavy lifting, strenuous exercise, and sexual activity. Potential complications from surgical removal include infection, bleeding that can form a hematoma (a collection of blood), or the recurrence of the spermatocele. Damage to the epididymis or the vas deferens is a risk that could affect fertility.
Aspiration and sclerotherapy involve less recovery time, with patients often able to resume normal activities immediately. However, this method carries risks, including the potential for recurrence if the sclerosing agent is not fully effective. There is also a risk of chemical epididymitis—inflammation caused by the sclerosing agent—or damage to the epididymis, which is why it is reserved for men who do not plan on future paternity.