Recurrent spermatocele

Please provide information on recurrent spermatocele—noncancerous gonadal cysts. I had surgery for spermatocele 5 years ago but the cysts have returned, along with pain. The only options suggested by the urologists I have consulted are more surgery or Advil for pain. Are there any other options available, either alternative or Eastern therapies for reduction of the cysts without surgery, or reduction of the pain?

First, you must be sure that the recurrent cysts are merely spermatoceles. Most spermatoceles are firm and nontender and will transilluminate light, hence, the easiest method to ensure these lesions do not involve the testes is to have a testes ultrasound. A spermatocele will show up clearly as a cystic structure near and connected to the epididymis. Another possible cause for localized pain in the testicle is epididymitis, which often responds to analgesics and antibiotics.

Usually, the pain from spermatoceles does not respond to medications. We are not familiar with any alternative therapies that would be able to alleviate this problem. Nonsteroidal antiinflammatory medications (such as Advil or Aspirin) may alleviate mild pain but will not resolve or cure the problem.

Needle aspiration of the cysts may be the best alternative for people who are poor not good candidates for surgery, but frequently fluid will accumulate again several weeks or months after this procedure. To prevent such reaccumulation of fluid, injection of sclerosing (thickening or hardening) medications (such as tetracycline, sodium tetradecyl sulfate, or urea) to the area may be performed after needle aspiration, to obliterate or close off the opening through the scrotal sac. However, possible complications after aspiration and injection of sclerosing agents include infection, fibrosis, or mild-to-moderate pain in the scrotal area for several days afterward.

Unfortunately, the only definitive treatment is surgical removal of the spermatocele and possibly also a small portion of the epididymis in some cases. In cases involving recurrence of the spermatoceles on only one side, it is recommended to have the entire epididymis surgically removed, but removal of the entire testicle is almost never necessary. This approach will ensure that there will not be a third trip to the operating room!

– Neil Baum, MD
Clinical Associate Professor
Urology Department
Tulane University School of Medicine
New Orleans, LA