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Indications for hydrocele and spermatocele treatment are based on diagnosis with high-resolution ultrasonography. It must be clear whether hydrocele or spermatocele lead to impairment of the patient - asymptomatic findings do not need correction. In case of younger men, the wish for children must be taken into account as both surgical procedures may lead to infertility, especially spermatocele resection may lead to epididymal obstruction. Advantages and disadvantages of the intervention must be discussed with the patient in detail. In men with a planned vasectomy, the physician must be certain that the patient understands the definitive character of this form of contraception. Men who are not aware of this condition or have conflicts with their partners may not be the best candidates for surgical vasectomy. All three treatment options (hydrocelectomy, spermatocele resection, and vasectomy) may be accompanied by fertility preservation procedures (e.g., cryopreservation of semen prior to surgery). Alternatively, the surgery should not be performed if any doubts exist. Postoperative management includes follow-up examinations and in case of vasectomy after 6-12 weeks and several ejaculations at least two semen analysis with proven azoospermia after centrifugation (or <100,000 immotile spermatozoa) should be documented. Compliance of men is best when this follow-up appointment is already scheduled at the time of surgery.

The majority of spermatoceles originate in retention cysts of the vasa efferentia. Cystic embryonic remnants of the testis and epididymis are not so frequent. Only 10 of 20 patients undergoing surgical treatment of unilateral, singular spermatoceles preoperatively showed normozoospermia. Excision of the spermatocele in more than 50% of our patients caused permanent deterioration of their spermiogramm. The number of sperms was reduced to less than the half of the preoperative counts. Obstruction of the epididymal duct caused by postoperative cicatrices is thought to be the reason. In consequence of these results operative treatment of spermatoceles should be though over. Our series clearly shows that the dissection of a spermatocele by no means should be practiced by way of treating infertility.