Degeneration of the seminiferous epithelium with ageing is a cause of spermatoceles?

A Post-Aspiration Giant Spermatocele in a Young Man: A Case Report and Literature Review

We report a case of a post-aspiration giant unilocular spermatocele in a young man. A 27-year-old man sought medical advice for a huge right scrotal swelling. The swelling first appeared following scrotal trauma and was aspirated. Shortly after, it reappeared and persisted for several years with a sense of heaviness, infrequent periods of right scrotal pain, and cosmetic concerns. Ultrasonography of the scrotum revealed a huge fluid cyst pushing the testis antero-inferiorly in the right hemi-scrotum. Scrotal exploration suggested the spermatocele nature of the cyst that emerged from the head of the epididymis. The cyst was excised, and its fluid content and wall underwent pathological examination for confirmation.

Microsurgical Epididymal Cystectomy does not Impact Upon Sperm Count, Motility or Morphology and is a Safe and Effective Treatment for Epididymal Cystic Lesions (ECLs) in Young Men With Fertility Requirements

OBJECTIVE

To assess the therapeutic efficacy and safety of microsurgical epididymal cystectomy for the treatment of epididymal cystic lesions in young men with fertility requirements and the impact of this surgery upon sperm quality and epididymal function.

MATERIALS AND METHODS

We prospectively evaluated the therapeutic outcomes, complications, safety and efficacy of microsurgical epididymal cystectomy and the impact of microsurgery upon sperm parameters. All patients were followed-up 3, 6 and 12 months after surgery to investigate sperm count, motility, morphology, neutral α-glucosidase, improvement of symptoms, recurrence, and complications.

RESULTS

Palpated cyst pain was evident in 32 out of 51 patients. Pathologists identified 29 spermatoceles and 22 epididymal cysts. Mean operation time was 39.27 ± 5.98 minutes, and the mean length of postoperative hospital stay was 2.02 ± 0.35 days. After surgery, scrotal pain disappeared in 80.4% of patients (41/51). A significantly higher rate of pain disappearance was observed in patients with palpated pain than those without palpated pain. Insignificant difference was seen in terms of sperm count, motility, sperm morphology or neutral α-glucosidase between preoperation and postoperation at 1-year follow-up. Sperm count and NGA in patients with an epididymal cystic lesions > 2.5 cm were significantly increased after surgery. The rate of complications was 7.3%. No cyst recurrence was observed during follow-up.

CONCLUSION

Microsurgical epididymal cystectomy does not impact upon sperm count, motility, morphology, or epididymal function and is a safe and effective surgical modality for young men with fertility requirements. Local palpated pain on the epididymal cyst is recommended as an optional surgical indication.

Risk Factors associated with Paraurethral Duct Dilatation following Gonococcal Paraurethral Duct Infection in Men

No studies have explored the risk factors for paraurethral duct dilatation following paraurethral duct infection by Neisseria gonorrhoeae in men undergoing ceftriaxone therapy. The present study was performed to explore the risk factors for paraurethral duct dilatation following paraurethral duct infection by N. gonorrhoeae in men undergoing ceftriaxone therapy and thus guide clinical interventions. We compared the demographic, behavioral, and clinical data of men with paraurethral duct infection by N. gonorrhoeae with and without dilatation of the paraurethral duct. Univariate analysis showed significant differences in age, disease course of the infected paraurethral duct, Chlamydia trachomatis infection in the paraurethral duct, and a history of paraurethral duct infection by N. gonorrhoeae between the patient and control groups (P<0.05). Multivariate logistic regression analysis showed consistent results (P<0.05). This study that shows delayed treatment may be a major risk factor for paraurethral duct dilatation secondary to paraurethral duct infection by N. gonorrhoeae in men. Age, C. trachomatis infection in the paraurethral duct, and a history of paraurethral duct infection by N. gonorrhoeae are also risk factors. Thus, educating patients to undergo timely therapy and treating the C. trachomatis infection may be effective interventions.

Bilateral Cystic Rete Testis in an Alpaca (Lama Pacos)

A 9-year-old intact male alpaca ( Lama pacos) was examined because of marked enlargement of the left scrotum. Ultrasound examination revealed a thin-walled anechoic structure in the area of the left testis. Aspirated fluid contained spermatozoa, many of which had abnormal morphology. Castration was performed and the left testis was markedly enlarged with a clear fluid-filled cyst. The cyst was lined by a single layer of squamous to cuboidal epithelial cells consistent with those originating from rete testis. The right testis was of a comparable size and shape to that of normal alpaca testis, but the rete testis was mildly to moderately dilated. Additional findings included chronic inflammation of the right testis and epididymis and epididymal fibrosis with ductal hyperplasia on the left. The diagnosis was bilateral cystic rete testis, most likely secondary to chronic inflammation.

Cystic dilatation of the rete testis: a hidden diagnosis among infertile men

Cystic dilatation of the rete testis, often also known as cystic ectasia of the rete testis, is a poorly understood condition that may be a cause of male infertility. This study examined the frequency of this condition in 749 men attending an infertility clinic with their partners. Of these 749 men, semen analysis was abnormal in 275 (37%) but apparently normal in 474 (63%). All the men attending the infertility clinic underwent a testicular ultrasound. Of these 749 men, the lesion was present in nine (1.2%); it was present bilaterally in three and unilaterally in six. In two men, one of whom had a bilateral lesion, the sperm count was normal. It is unclear whether this lesion is a cause of infertility but it is important that this condition is diagnosed so that its prevalence and its relationship to infertility can be ascertained.

Giant Spermatocele Mimicking Hydrocele: A Case Report

Spermatoceles are usually asymptomatic and often found incidentally during physical examination. We report a case of giant spermatocele that mimicked a hydrocele. A 55-year-old man suffered from right scrotal enlargement for several years. As the heavy sensation and scrotal soreness worsened in recent months, he came to our outpatient clinic for help. Hydrocele was suspected due to transilluminating appearance of the scrotal content. Surgical exploration was arranged and a giant spermatocele was found. Total excision of the spermatocele was performed and the patient recovered well. The specimen was sent for pathology and spermatocele with spermatozoa was noted.

Clinical and Pathological Findings in Testis, Epididymis, Deferens Duct and Prostate following Vasectomy in a Dog

We report the case of a bilateral and multilocular spermatocele and sperm granuloma in a dog that was vasectomized 5 years before. Clinical examination revealed scrotal dermatitis and benign prostatic hyperplasia. Orchiectomy was performed, and gross and histological examination showed testicular degeneration associated with epididymal sperm granuloma. In relation to this case, the literature about long-term effects of vasectomy in dogs has been reviewed. On the basis of these results, a preventive sonogram and physical assessment in prostate and other reproductive structures before vasectomy is recommended.

Primary bilateral spermatocele

We report the case of a bilateral, relatively huge, multilocular spermatocele diagnosed at sonography with surgical and pathological correlation. A 45-year-old man presented with bilateral, large inguinoscrotal masses. He had had the masses since his adolescence and their size gradually increased in the past 5 years. Scrotal ultrasonographic examination showed cystic fluid masses that were 65 x 45 x 50 mm in size on the right and 55 x 45 x 40 mm in size on the left side in multilocular spaces. The cystic masses were excised via bilateral inguinoscrotal incision staying near the body of the epididymis. The patient had fathered three children with no fertility problem.

Pro-inflammatory cytokine response of the fluid contents of spermatoceles and epididymal cysts

The aim of the study was to determine the cellular contents and concentrations of interleukin 6 (IL-6), interleukin 8 (IL-8) and tumour necrosis factor alpha (TNF-alpha) in fluids of patients with spermatocele or epididymal cyst. Twenty-five symptomatic patients, 14 with epididymal cysts and 11 with spermatoceles, were included in the study. Fluids were obtained during surgical excision of the cysts and cytological smears were stained with May-Gruenwald-Giemsa to establish cell components. The concentrations of IL-6, IL-8 and TNF-alpha were measured by chemiluminescent immunometric assay. Cytological analysis of the fluids demonstrated various sperm forms ranging from immature germ cells to degenerated spermatozoa without inflammatory cells such as neutrophils and macrophages. The concentrations (mean+/- SEM, pg/mg protein) of IL-6, IL-8 and TNF-alpha were 13.52 +/- 1.40, 22.20 +/- 2.43, 3.51 +/- 1.43 in spermatocele fluids and 5.76 +/- 0.48, 11.57 +/- 1.89, 2.53 +/- 0.41 in epididymal cyst fluids. Both IL-6 and IL-8 concentrations in the spermatocele group were higher than in the epididymal cyst group (P < 0.0001). There were no differences in TNF-alpha concentrations between the groups (P > 0.05). These findings indicate that local production of pro-inflammatory cytokines is involved in cyst formation. The presence of immunologic activation in these fluids advocates a policy of selective surgical intervention in patients with spermatocele or epididymal cyst.