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Epididymal cysts are benign cystic formations of the epididymis that usually appear in adolescence or early adulthood. Their frequency doubles after the age of 14-15. Obstruction in the epididymal efferent ductules with subsequent prostenotic dilatation of them, as well as dysgenesis due to hormonal disorders during fetal or postnatal life, are possible. At the 1st Department of Pediatric Surgery of A.U.Th. we treated 11 cases of boys at the age of 11-16 who presented with acute scrotum because of an epididymal cyst. The diagnosis was confirmed by ultrasound scanning . Due to persistent symptomatology, patients underwent surgical exploration and removal of the cyst. The postoperative care of the patients was uncomplicated with immediate remission of symptoms. In one case, ipsilateral acute epididymitis occurred after 10 days, which was successfully treated with antibiotic therapy. It is reported that approximately 50% of epididymal cysts involute within an average of 17 months. In conclusion, using the data obtained from the review, of the small in number of international bibliography studies, it is proposed conservative treatment of asymptomatic cysts with diameter smaller than 1 cm and surgical excision [1] of large asymptomatic cysts with diameter greater than 1 cm, which do not regress after a follow-up of 24-48 months, cysts, regardless of their diameter, responsible for persistent symptoms and in the manifestation of acute scrotal symptoms due to inflammation, intravesical bleeding or secondarily torsion of the epididymis.

Epididymal cysts mostly occur in men aged 20-40 years old. Previous reports have covered concerns about postoperative complexes, including postoperative asoedema, hematoma, sustaining pain, and seminal tract obstruction in patients who have undertaken nonmicroscopic epididymal cyst resection or epididymal resection. Nonmicroscopic epididymal cyst surgery is suggested for patients with childbirth plans as a precaution. The treatment of male epididymal cysts via microtechnology is obviously a beneficial option; we took the lead in carrying out microscopic epididymal exploration and cyst resection surgery in China. From September 2017 to April 2021, 41 young and middle-aged male patients diagnosed with epididymal cysts underwent microtechnology treatment in a program titled "microscopic epididymal exploration and cystectomy". The postoperative follow-up lasted for 3-50 months. The results confirmed that, as microscopic manipulation largely improved visualization of the subtle tissue structures of the epididymis, the cyst could be clearly dissected apart and completely removed intact under the microscope. Bleeding during the operation was significantly reduced (2-3 mL) and wound drainage was not required. According to follow-up data, microscopic treatment significantly reduced the incidence of postoperative scrotal hematoma, edema, and long-term postoperative pain, thereby promising a higher surgical success rate as well as recurrence prevention. Besides, preliminary experience and reflection suggest that microscopic epididymal exploration and cystectomy provide efficient preservation of the epididymal patency through refined treatment, while a better prognosis can be achieved. We recommend that surgery be carried out before the epididymal cyst develops to 0.8 cm in diameter, for fear that a larger epididymal cyst (>0.9 cm in diameter) could cause the complete destruction of all tubules of the ipsilateral epididymis - a more severe case with damage to the testicular output network.

Objective: Gold standard treatment of symptomatic hydrocele or spermatocele is surgery. Despite a minor procedure, complications such as bleeding and infections leading to reoperations may be devastating for the patients. In autumn 2018, an accumulation of complications was seen in our department. The aim of this study was to investigate the rate and grade of complications and to identify potential means to reduce these., Materials and Methods: Patient records of all patients undergoing surgical repair of hydrocele or spermatocele from December 2017 to November 2018 were examined. Results were audited to identify potential causes of complications. The focus was on the perioperative hemostasis and postoperative activity restrictions. The outcome was compared to a consecutive patient series operated the following year., Results: Sixty-five men were operated on during the first period. Twenty-two patients contacted the department postoperatively due to swelling or pain, 19 patients were examined at the hospital and six patients were re-operated 1-9 times. The following year, 69 patients were operated on. Of these, 16 patients contacted the department postoperatively ( p  = 0.17), 13 patients were examined at the hospital, and five patients were re-operated ( p  = 0.68). There was the same complication rate in patients operated by specialist urologists or supervised younger doctors. However, patients preoperatively examined and informed by a specialized urologist had significantly fewer complications compared to those informed by urological residents and interns ( p  = 0.012)., Conclusion: Despite the change in patient information and increased awareness of possible complications, a high proportion of patients still were in need of unplanned contact to the department and reoperation.

Torsion of an epididymal cyst is an extremely rare cause of acute scrotum in children and in young boys. Its reported incidence is 5-20%. The treatment is usually conservative. Many cases (up to 60%) regress spontaneously, especially if below 3 cm. Few cases have been reported in Literature (7 cases/2018). We add our patient as eighth case. He was a 13-year-old boy who was admitted for acute scrotum. Ultrasound excluded torsion of the testis and he was managed for 5 day conservatively. Based on clinical history and physical exam, we decided to perform a prompt surgery that revealed a torsion of epididymal cyst that was confirmed by histological exam.

Objectives: To estimate the incidence of men seeking specialized care and receiving treatment for hydro or spermatocele complaints. Also, to determine the risk of complications of treatment. Materials and methods: The total number of men living in Sweden each year from 2005 to 2014 was used to calculate incidence and age distribution of adult (≥18 years) men seeking specialized healthcare with either hydro or spermatocele. This was done by using nationwide registries, mandatory by law. They contain information on primary or discharge diagnosis, procedure codes and antibiotic prescriptions. Also, complication rates comparing aspiration (with or without sclerotherapy) and conventional surgery were analysed. Results: The incidence of men with either hydro or spermatocele diagnosis in specialized healthcare was ∼100/100,000 men. The treatment incidence was 17/100,000 men. Orchiectomy was used as primary treatment in 2.4% of cases. The risk of experiencing a complication was clinically and statistically significantly increased with conventional surgery as compared with aspiration, 17.5% (1607/9174) vs 4.6% (181/3920), corresponding to relative risk of 3.79 (95% CI = 3.27-4.40). Hematoma and infections were the most common complications. Conclusion: Hydro and spermatoceles are common, affecting elderly men. Aspiration seems advantageous with respect to complications and can be recommended due to the benign course of the disease. The indication for conventional surgery might be questioned such as the use of orchiectomy as primary treatment.

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., (Copyright © 2018. Published by Elsevier Inc.)

Epididymal cysts (ECs) are relatively common in adults, rare in children. Normally their treatment is conservative. They may be situated anywhere in the organ, frequently in the region of the head. Torsion of these cysts is extremely rare in both children and adults, causing acute scrotal swelling. The diagnosis is intraoperative. A 16-year-old boy was referred to our Divisional Clinic by the treating physician for scrotal swelling appeared 4 months earlier. Absence of a history of minor scrotal trauma. Ultrasonography showed a 40×50 mm fluid-filled right para-testicular mass. We performed surgery finding a large black cyst connected to the head of the epididymis with 720°-degrees rotation. Histology revealed an acquired EC. The particularity of our case is due to the absence of symptoms in association with a big EC twisted of 720° degrees. This is the only case reported in literature. All patients with EC torsion reported presented symptoms related to acute scrotum.

Objective: The primary aim of this study was to assess the complication rate after elective scrotal surgery for benign conditions, following the observation that a higher than expected number of patients were requiring intervention for complications of their surgery. The secondary aim was to assess how different risk factors affected the complication rate, therefore identifying areas for improvement in clinical practice., Materials and Methods: All patients from April 2008 to September 2013 who underwent an elective hydrocele repair, epididymal cyst excision or epididymectomy at a UK district general hospital were included. Patient notes were reviewed and risk factors for surgery and postoperative complications recorded., Results: In total, 222 patients were included. The overall complication rate was 27.4%. Complications included haematoma (9.0%), infection (5.0%), recurrence of swelling (7.2%) and chronic pain (0.2%). The only risk factor to have a significant relationship to complication rate was a body mass index of 30 kg/m² or greater (χ² = 6.698, p = 0.010)., Conclusions: The most common complications after scrotal surgery for benign conditions were haematoma formation, infection and recurrence or persistence of swelling. The only risk factor identified as having a potentially adverse effect on complication rate was a raised body mass index of 30 or greater.

Intraparenchymal epididymal cysts (IECs) are benign cystic formations of the epididymis of unknown pathogenesis, which typically appear in adolescence or adulthood. In patients older than 14 years old their prevalence is doubled. After systematic and thorough research of the current literature, we did not find another case report of intraparenchymal epididymal cyst with similar dimensions. The male patient, 15 years old, visited our outpatient department complaining of pain in the right hemiscrotum. Diagnosis of IEC was confirmed after the conduction of ultrasound examination. Patient underwent surgical exploration of the right hemiscrotum. Resection of the IEC followed. Postoperative course was uneventful, with recession of the symptoms. In our opinion, IECs should be surgically removed, either when they are symptomatic or when they are asymptomatic, but of a diameter greater than 1 cm and without regression tendency.

A 2-year-old intact male South African Boerboel presented for semen cryopreservation and was discovered to be azoospermic. The dog had excellent libido and had sired litters within 6 months, so a further investigation of why his collection lacked sperm was warranted. On further examination of his scrotal contents, his right epididymis had an enlarged area with a hard texture. Ultrasonography revealed that the enlarged area of the right epididymis was fluid filled. A sample of the fluid was aspirated for aerobic culture. No bacteria showed growth. Although the culture was negative, it was suspected that this dog had an epididymitis or epididymal abscess, and treatment with enrofloxacin at 10mg/kg orally was initiated for 4 weeks. The abnormal texture and fluid-filled cavity in the right epididymis persisted, despite antibiotic therapy. Cytology of a repeat aspiration of the fluid-filled area after antibiotic therapy revealed a mixture of red blood cells and sperm. Owing to the potential for blood-testis barrier disruption, a unilateral orchiectomy of the right testicle was performed, as an attempt to protect future sperm production of the remaining testicle. A spermatocele was confirmed on histopathology. After another month, an excellent-quality semen sample was collected, with 90% progressive motility, good concentration, and few morphologic abnormalities. A subsequent collection was acquired and was successfully cryopreserved for future breeding. In dogs with spermatoceles, semen quality can be preserved with aggressive treatment to remove the affected testicle. The disruption of the blood-testis barrier in spermatoceles may result in antisperm antibody production and eventual infertility; however, cryopreservation can result in long-term options for owners seeking to continue using an animal in their breeding program., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Purpose: Hydrocelectomy and spermatocelectomy are routine scrotal surgeries. A significant number of the surgical specimens are sent for pathology analysis. However, to our knowledge no study has been done to examine outcomes and necessity, which results in significant potentially unnecessary costs to the patient and the health care system. We evaluated outcomes and surgical pathology analysis of hydroceles and spermatoceles., Materials and Methods: We performed a retrospective, single institution chart review of all patients who underwent initial surgery for hydrocele or spermatocele between January 2000 and August 2013. We determined the number of cases in which a surgical specimen was sent for pathology examination. The cost for each specimen was estimated at the department of pathology., Results: A total of 264 routine scrotal cases were performed during the 14-year period. Surgical specimens were sent for pathology analysis in 102 hydrocelectomy cases (51%) and in 57 spermatocelectomy cases (90%). No pathology specimen showed any indication of malignancy. The estimated direct total cost of pathology analysis was $49,449 in this cohort., Conclusions: No malignancy was detected in 159 hydrocele and spermatocele specimens during the 14 study years, suggesting that the pathology analysis is of little clinical benefit. Forgoing surgical pathology analysis of these specimens would result in significant cost savings to the patient and the health care system., (Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

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.

Introduction: Varicocele is the main cause of infertility in male and the most correctable cause of it too. In this study, we present our experience on 34 patients affected by bilateral varicocele and other scrotal comorbidities treated underwent surgery with a scrotal access., Materials and Methods: 34 patients were enrolled with clinical palpable and infraclinical (ultrasonic doppler scanning) bilateral varicocele and other comorbidities like right hydrocele, left hydrocele, bilateral hydrocele, and epididymal cyst. They all underwent scrotal bilateral varicocelectomy under local anesthesia., Results and Discussion: At 6 months, no other complications were reported. No case of testicular atrophy was observed. None had recurrence of varicocele. All scrotal comorbidities were treated as well., Conclusion: Scrotal access with local anesthesia is a safe and useful technique to treat patients with bilateral varicocele and other scrotal comorbidities.

The Aim of the Study: To decide on the accurate way of treatment and to establish criteria for operation in boys with pubertal epididymal cysts (ECs)., Material and Methods: Results of scrotal ultrasound of 363 boys and adolescents, aged 2 months to 18 years, were reviewed retrospectively., Results: Of all 363 patients with scrotal ultrasound 59 (16.2%) at mean age of 14.03 yrs had ECs. The EC incidence increased with age and 42 out of 124 boys (33.8%) older than 14 yrs had cysts (chi2=27.627, p=0.000). Out of 59 patients, in 30 (50.8%) cysts were diagnosed incidentally at the time of scrotal US, 29 boys (49.2%) presented with scrotal mass and/or pain. 31 patients with ECs (52.5%) underwent elective surgery and the remaining 28 boys (47.5%) received conservative treatment. The age of boys with ECs who underwent surgery ranged from 8 to 18 years (mean 14.32). The age range of patients treated conservatively was 7-18 (mean 13.71). There was no statistical difference in age between boys treated surgically and conservatively (t=0.924, p=0.36). ECs resolved in 17 patients out of 28 boys treated conservatively, in remaining 11 boys the size of cysts was stabile and they remain asymptomatic. Clinical and ultrasonographic follow-up were carried out from 11 months to 5 years., Conclusions: ECs are more common in older boys (over 14 years). Management of ECs smaller than 10 mm should be conservative with clinical and ultrasound controls, leaving surgery for cysts increasing in size over 10 mm which did not involute with time.

Purpose: A microsurgical approach to spermatocelectomy theoretically minimizes the risk of injury to the epididymis and testicular blood supply. We present the technique of microsurgical spermatocelectomy and report our perioperative and recurrence outcomes., Materials and Methods: In a 15-year period 23 men with a total of 36 epididymal cystic masses underwent microsurgical resection with confirmation of spermatocele diagnosis by intraoperative identification of sperm in the cyst fluid. We reviewed pathology reports for resected epididymal tissue in the spermatocele specimen. Postoperative outcome measures included complications, sperm count changes, improvement in pain and fertility, and cyst recurrence., Results: Mean spermatocele size was 5.0 cm (range 1 to 15). Common indications for surgery included pain in 35% of cases, infertility in 30% and the 2 conditions in 13%. A total of 13 patients (57%) underwent simultaneous procedures for concomitant varicocele and/or hydrocele with a mean overall surgical time of 152 minutes. A single scrotal hematoma managed conservatively was the only postoperative complication. There was no case of infection. Avoidance of inadvertent epididymal resection was shown by absent epididymal tissue in each of the 36 spermatocele pathology specimens. Also, no patient with preoperative and postoperative semen analyses available experienced a decreased sperm count, confirming the avoidance of iatrogenic epididymal tubule obstruction. At a mean followup of 17.3 months no man had cyst recurrence or testicular atrophy and all with preoperative pain reported improvement. One patient with preoperative infertility achieved pregnancy 12 months after surgery., Conclusions: Microsurgical spermatocelectomy is safe and effective with a minimal risk of epididymal injury, testicular atrophy and recurrence., (Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

We identified 5 cases of hydrocele and spermatocele resections containing detached small cellular "blue" clusters, raising questions of small cell carcinoma by contributors to our consult service. Patients were 37, 39, 52, 67, and 70 years old. None of the 4 patients with follow-up developed small cell carcinoma. On routine stained sections, there were multiple clusters of detached hypercellular cells with focal streaming, high nuclear-to-cytoplasmic ratios, and hyperchromatic nuclei without prominent nuclei. There were no mitotic figures, apoptotic bodies, or necrosis. In 4 of 5 cases, there was sufficient tissue to perform immunohistochemistry along with 10 cases each of normal rete testis and epididymis. CD56 was positive in 4 of 4 cases of the "blue cells" and in 9 of 10 of normal rete testis; yet, it was positive in only 2 of 10 normal epididymis. Synaptophysin and chromogranin were negative in all cases of "blue cells." PAX2 was negative in all cases of "blue cells" similar to the 1 of 9 positive staining in rete testis and in contrast to the positivity seen in 9 of 9 cases of normal epididymis. Ki-67 was negative or showed only rare positive cells in all of the cases of the "blue cells." Clusters of blue cells suggestive of sloughed rete testis cells can mimic small cell carcinoma in hydrocele and spermatocele specimens based on their low power appearance and positive CD56 staining. Closer examination of the cells' bland morphology, low expression of Ki-67, and lack of chromogranin and synaptophysin, along with recognition of this entity, can prevent a misdiagnosis of malignancy.

Androgen insensitivity syndrome is a disorder of sexual differentiation with 46XY karyotype. The gonad is at risk (33% by 50 years of age) for development of malignant tumors. Hence, gonadectomy is warranted. We present a case of a 22-year-old woman diagnosed with androgen insensitivity syndrome during investigation of primary amenorrhea. Ultrasonography showed intraabdominally-located gonads, with a large, nontender cyst of 9.2 x 5.6 x 5.4 cm size, with limited mobility, to the right of the midline. There was also a partial septum, with a wall thickness of 1 to 2 mm and containing clear fluid. Because of suspicion of malignancy, complete surgery including laparoscopic peritoneal cytologic study, gonadectomy, lymphadenectomy, and omentectomy were performed. Histopathologic study showed testis with an epididymal cyst. Formation of epididymal cyst is rare in these cases. The patient did well in the postoperative period. She was put on hormone replacement therapy and is doing well.

We report 2 rare cases of intrascrotal tumors complicated acute scrotum. Case 1: A 15-year-old adolescent presented to our emergency room with acute right scrotal pain. Testicular torsion was suspected, and surgical exploration was performed. A spermatocele with 180 degrees torsion on its pedicle was observed. The patient was diagnosed with torsion of a spermatocele, and it was excised. Case 2: A 25-year-old man presented with acute left scrotal pain. Testicular torsion was suspected, and manual detorsion relieved the pain effectively. However, scrotal swelling did not subside after detorsion, and surgical exploration was performed. The left testis was stony hard on palpation, and intraoperative ultrasound revealed a mosaic echo pattern. A testicular tumor was highly suspected and left high orchiectomy was performed. Histopathological examination revealed seminoma pT1. Torsion of a testicular tumor was diagnosed. Although these 2 cases are extremely rare, they should be considered for the differential diagnosis of acute scrotum.

Introduction: Testicular torsion is a rare pathology in adults. While it generally develops as a consequence of certain congenital abnormalities in pediatric and adolescent patients, the exact mechanism in adults remains unclear., Case Presentation: A 57-year-old man initially diagnosed with right epididiymal cyst, when presented with severe right-sided scrotal pain six months later, was found to have a 720-degree right testicular torsion on surgical exploration., Conclusion: Testicular torsion should be considered in the differential diagnosis of acute scrotum, regardless of patient age. We report a case of testicular torsion in the elderly patient, which may offer a contribution to the literature regarding the etiology of adult testicular torsion.

To form spermatocele from vaginal layers as a sperm reservoir and intra-uterine insemination (IUI) in infertile men with bilateral vas agenesis (BVA), we studied 19 patients with azoospermia due to BVA referred to our infertility clinic from March 1992 until May 2003. The ages of the patients ranged from 20-41 (mean 29.6+/-5.8) years. After physical examination, hormone assay, testis biopsy, and confirming normal spermatogenesis, we have performed 23 alloplastic spermatoceles from the tunica vaginal layers in 11 patients. We retrieved sperms and performed IUI in 6 patients' wives 3 months post-operation when scrotal sonography revealed spermatocele with a good volume of seminal liquid. Among 6 patients' wives, 2 successful pregnancies occurred, and 2 normal babies (one boy with normal bilateral vas and one girl) were delivered successfully by cesarean section. We conclude that although the method of choice for fertility in BVA in artificial reproductive therapy era is percutaneous epididymal sperm aspiration (PESA) and intracytoplasmic sperm injection (ICSI), but when the sophisticated facilities are not available or cost-effectiveness is matter of concern, alloplastic spermatocele from tunica vaginalis and IUI may be a viable option.

Spermatoceles are benign cystic dilations of the epididymis. Despite their relatively common occurrence, it is not clear why or when men want this lesion treated. We present a single institution series of men undergoing spermatocelectomy. We describe the clinical characteristics of men with these lesions and hypothesize that men with spermatoceles seek intervention when the lesion approximates the size of a testicle. The characteristics of 24 men who sought excision of symptomatic spermatoceles were reviewed. Specific characteristics included subject age, duration of diagnosis, symptom type, and symptom duration. Spermatoceles were characterized by size, sidedness, and associated findings. Simple descriptive statistics were used for analysis. The mean age of men seeking spermatocelectomy was 46 years. Most men (58%) sought surgery due to a combination of pain and sensation of mass. The mean duration of symptoms was 48 months. At the time of excision, the average size of spermatoceles was 4.2 cm in greatest diameter, and most (71%) were right sided. Men who experienced pain as an isolated symptom were younger by approximately 10 years compared to those who experienced mass. Men in this series appear to tolerate spermatoceles for a relatively long period of time. Once they seek excision, spermatoceles have grown to roughly the size of a normal testicle and men are bothered both by pain and mass symptoms.

We report the very rare case of bilateral spermatoceles concurrent with bilateral scrotal hydrocele presenting huge scrotal swelling. A 52-year-old man came to our hospital because of large scrotal swelling. Ultrasonography and magnetic resonance imaging showed bilateral large scrotal hydroceles concurrent with bilateral multicystic spermatoceles above the hydrocele. He had no history of vasectomy or scrotal injury, and the semen examination was normal. The contents of the hydroceles and spermatoceles were first aspirated, but hydrocelectomy and spermatocelectomy were eventually done because after the aspiration the fluid increased more rapidly. Bilateral spermatocele is very rare; moreover, this is the first report of bilateral spermatocele concurrent with bilateral hydrocele.

Purpose: We evaluated the risk of epididymal injury in patients undergoing hydrocelectomy and spermatocelectomy, and determined risk factors that may increase the chance of epididymal injury. To our knowledge the incidences of epididymal injury during hydrocelectomy and spermatocelectomy have not previously been reported., Materials and Methods: The pathology reports of all patients undergoing hydrocelectomy and spermatocelectomy at a single institution from 1990 to 2003 were retrospectively reviewed to determine if a portion of the epididymis was present in the pathology specimen. Patients with epididymis present then underwent a chart review to determine possible risk factors for epididymal injury., Results: A total of 338 adults underwent unilateral or bilateral hydrocelectomy from 1990 to 2003. Another 111 patients underwent spermatocelectomy during this period. In 19 patients (5.62%) epididymal injuries were documented during hydrocelectomy and in 19 (17.12%) epididymal injuries were documented during spermatocelectomy. No specific risk factors could be identified., Conclusions: The risk of epididymal injury during hydrocelectomy and spermatocelectomy is significant. Patients must be informed of this risk since epididymal injury may lead to infertility. To our knowledge this is the first published report documenting the incidence and risk of epididymal injury during hydrocelectomy or spermatocelectomy.

Purpose: We determine the incidence of complications following outpatient scrotal surgery for the treatment of hydroceles and spermatoceles., Materials and Methods: A retrospective study of all patients undergoing hydrocelectomy or spermatocelectomy between April 1, 1997 and March 31, 1999 at 1 institution was performed. The hospital and office charts were reviewed, and postoperative complications (infection, persistent swelling, chronic pain) were recorded. The type of preoperative antiseptic preparation (iodine based versus chlorhexidine) and the presence or absence of surgical drains were also recorded., Results: A total of 161 patients were included in the study with an average age of 53.7 years. The overall complication rate was 19.2%. Infection/scrotal abscess formation occurred in 9.3% of patients, persistent swelling (treatment failure) in 9.3% and chronic pain in 0.6%. There was no significant difference in the complication rate when the preoperative preparations and the presence or absence of surgical drains were compared., Conclusions: The most common complications following scrotal surgery for hydroceles and spermatoceles are persistent scrotal swelling, inflammation and postoperative infection. Further prospective investigation is required to study factors such as the use of drains, preoperative and/or perioperative antibiotics and the type of surgical preparations, which may have a role in complication rates.

Objectives: To evaluate the amount, motility, and viability of sperm in fluid aspirated from naturally occurring spermatoceles and to investigate the effect of cryopreservation of sperm retrieved from spermatoceles. Assisted reproductive technologies have led to successful pregnancies and deliveries using sperm harvested from the epididymis and/or testis of infertile men., Methods: Aspiration of spermatocele fluid and analysis of the fluid obtained was performed on 20 patients before elective spermatocelectomy. Randomly selected samples (n = 5) were washed using a 70% Percoll gradient, and repeated semen analysis was performed. The washed specimens were cryopreserved in liquid nitrogen, and repeated semen analysis was performed on the thawed specimens., Results: All spermatoceles (n = 20) had viable sperm present (count range 54 x 10(4) to 326 x 10(6)) and 16 (80%) of 20 contained motile sperm. The average percentage of motile sperm was 5%. The average sperm motility and average percent viability of sperm recovered after Percoll gradient improved compared with sperm in the initial spermatocele aspirates (motility 5%, range 0% to 25% and viability 36%, range 2% to 91% before Percoll vs. motility 13%, range 2% to 38% and viability 39%, range 10% to 92% after Percoll). Sperm retrieved after cryopreservation demonstrated reduced motility and viability; however, motile and viable sperm were recovered from all washed and cryopreserved samples., Conclusions: Our results suggest that spermatocele fluid may contain sufficient numbers of sperm for use with assisted reproductive technologies. Motile and viable sperm can be recovered after cryopreservation and storage of sperm obtained from a spermatocele. Spermatocele fluid may be an additional source of sperm for assisted reproductive technologies.

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.

Objective: To evaluate the justification for operative intervention in patients undergoing surgery for benign scrotal pathology, and to assess the associated morbidity., Patients and Methods: Consecutive patients in two surgical firms who underwent surgery for benign intrascrotal pathology over a 5-year period were studied retrospectively., Results: In all, 102 patients were included in the study (mean age 51.6 years, range 16-86). Most patients had either epididymal cysts (59) or hydroceles (31) or a combination of the two (eight). Some patients (37) underwent ultrasonography before surgery. The indications for surgery were deemed to be strong in 25% of patients but weak or absent in the remainder. Complications occurred in 31 patients, being minor in 18, but significant in 13, resulting in four re-admissions to hospital. There was no significant difference in the complication rate between those patients with strong indications for surgery (37%) and those with weak indications (28%)., Conclusions: Surgery for benign intrascrotal pathology is frequently undertaken for weak clinical indications and carries significant associated morbidity. This could be avoided in many cases by simple reassurance. Judicious use of ultrasonography is advised. A policy of selective surgical intervention is strongly advocated.

We describe a case of a multilocular spermatocele. Ultrasound examination revealed several cystic spaces at the head of the left epididymis. Epididymal tumor could not be excluded, and therefore surgical exploration was performed. Histopathological examination of the specimen revealed a multilocular spermatocele arising from the rete testis. Most spermatoceles remain small and rarely present marked clinical problems. but they are occasionally large, and may simulate a solid tumor.

Background: Cystic transformation of the rete testis is a little-known partial or complete obstruction of the spermatozoa-containing secretion of the head of the epididymis. Depending on its severity, either ectasia or a cystic transformation occurs, which spreads to the network of convoluted seminiferous tubules in the mediastinum testis. Findings in contrast-enhanced MRI examinations are characteristic and may help to differentiate this benign entity from malignant neoplasia. The authors present two pronounced cases in different stages, documenting the broad spectrum of possible involvement.

High resolution ultrasound has increased our awareness of benign testicular cysts that appear to arise from the intratesticular sperm conduit system of the intratesticular ducts of the mediastinum and rete testis. The location of these benign cysts in the area of the mediastinum and rete testis and the absence of signs of a germ cell tumor may permit testicle preservation. These benign cysts may contain sperm. We present a case of a benign sperm-containing cyst with visible communication to the rete testis, designated an intratesticular spermatocele and managed with testicle preservation.

Torsion of a spermatocele combined with aplasia of the vas deferens is described. The purpose of this case report is that this rare condition should not be omitted from the differential diagnosis of the acute scrotum in childhood. The authors also support that the term "spermatocele" could be used in the non semen producing age of childhood, based upon the non age-dependent pathologic criteria.

The endoscopic therapy has an elective role in the distal obstructive azoospermia for urogenital carrefour pathologies both organics and functional and differently in the resection and/or aspiration with sperm recovery forms. Resolutely attends to the symptomatology and positively to the fertility re-establishment, in front of a short sickness-rate. The Authors describe the different techniques with relative indications, results and complications. Instead medical therapy has a role in the obstructive above all post infection and post inflammatory lesions prevention. Furthermore propose to oneself the goal to improve the seminal quality by the improvement of the semen fertilization capacity and to reduce the affections symptomatology. Finally concurs with the sperm selection techniques to fertility potential wealth.

The authors describe the technique of scrotal elevation and compression for the prevention of postoperative scrotal hematoma. This technique was used in 30 patients undergoing hydrocelectomy, spermatocelectomy or epididymectomy. There have been no untoward effects associated with this technique and this technique is applicable to a wide variety of scrotal procedures. The method described is simple, rapid to perform, comfortable for the patients and most effective to prevent postoperative complications in patients undergoing a scrotal operation.

We describe, to our knowledge, the first 2 cases of torsion of a spermatocele. This condition should be considered in the differential diagnosis of an acute scrotum in the adult.

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.

Almost every scrotal operation may be done with local anesthesia. Occasionally general anesthesia may be elected, but the basic orientation to scrotal surgery should be with local anesthesia as long as the operation can be completed within 3 hours. The only scrotal operation for which I routinely elect general anesthesia is bilateral vasoepididymostomy because this is the only scrotal procedure that takes over 3 hours. Very rarely a scrotal hernia or a huge hydrocele obscures the cord, preventing administration of local anesthesia. Aside from these rare exceptions, I perform all scrotal surgery with local anesthesia. The use of preoperative sedation makes it possible for all patients to tolerate the small amount of discomfort associated with injection of a local anesthesic. Once the anesthetic is injected, scrotal surgery is painless. Regardless of the choice of local or general anesthesia, virtually all patients are discharged to home on the day of surgery. All scrotal surgery should be considered to be ambulatory surgery.