Posts Tagged ‘scrotal mass’

Big Ball Series: What You Need to Know About Spermatoceles

November 3, 2018

Andrew Siegel MD 11/3/2018

This is a continuation of the “Big Ball” series of entries, which provide information about common maladies that affect the contents of the scrotum.  The previous entry was on hydroceles and next week will cover epididymitis. 

Epididymis-KDS

A. epididymal head, B. body, C. tail, D. vas deferens (sperm duct)                             Attribution: By KDS444 [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)%5D, from Wikimedia Commons  

A spermatocele (“spermato” = sperm + “cele” = sac) is a benign cystic enlargement within the scrotum that results from a partial obstruction of the tubular system of the epididymis.   The epididymis is the comet-shaped organ located above and behind each testicle that consists of multiple tiny twisted tubules. The epididymis is the site where sperm cells mature and are stored until the time of sexual climax when they move from the epididymis into the vas deferens (sperm duct).     

Spermatoceles typically arise from the head of the epididymis and are found to contain sperm, hence the name.  They can vary greatly in size, ranging from a pea-size lump that does not cause any symptoms to a grapefruit-size enlargement that causes annoying symptoms.  Many men with spermatoceles often present to the urologist with the complaint of “growing a third testicle.”  They are evaluated by physical examination where they are found to be smooth, soft and regular masses typically located above the testicle.  They are often further characterized by scrotal ultrasonography that provides detailed anatomical imaging of the testes and epididymis and can differentiate a spermatocele from other causes of scrotal enlargement such as a hydrocele. However, an epididymal cyst may be impossible to distinguish from a spermatocele, the only difference being that an epididymal cyst does not contain sperm as does a spermatocele. 

Spermatocele

Ultrasound image of spermatocele,  public domain (spermatocele on left immediately adjacent to testes on right)

The majority of spermatoceles arise from the epididymal head, although they can arise from the body or tail. Many spermatoceles are not symptomatic, causing only a painless enlargement or are discovered on a routine physical exam or incidentally on a scrotal ultrasound done for another reason.  Larger spermatoceles can cause an uncomfortable dragging sensation, particularly while sitting or driving. Most small and moderate-size spermatoceles can be managed simply by careful periodic observation to ensure that they do not continue to enlarge or cause progressive symptoms. When a spermatocele progresses to the point where it causes discomfort, pain, or deformity, it can be repaired by a relatively simple surgical procedure performed on an outpatient basis.  The incision is typically through the midline “seam” of the scrotum; the involved testicle is delivered through the incision, the epididymis is exposed and the spermatocele is carefully excised, after which the scrotal contents are repositioned and the scrotal wall is closed.  This procedure is a highly successful means of treatment of the spermatocele.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor

 

 

 

 

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Big Ball Series: What You Need to Know About Hydroceles

October 27, 2018

Andrew Siegel MD  October 27, 2018

This is the first entry in the “Big Ball” series, which  provides information about common male issues that affect the contents of the scrotum.

 

huge hydrocele

 

Image above, a very large hydrocele

A hydrocele (“hydro” = water + “cele” = sac) is an accumulation of fluid within the sac that surrounds the testicle, resulting in ballooning and enlargement of the scrotum.  It can vary in size from just slightly bigger than the actual testes to larger than a cantaloupe.

Each testicle is surrounded by a thin sac known as the tunica vaginalis. The tunica  has an inner layer and an outer layer, with a small amount of fluid present between these 2 layers that serves a lubrication function, providing the means for the testes to rotate and move freely within the scrotum. The inner layer is responsible for the manufacture of this fluid and the outer layer for its reabsorption. This is a dynamic and ongoing process. A hydrocele is simply a disorder of production/reabsorption such that the outer layer of the tunica is unable to reabsorb all of the fluid that is produced by the inner layer, with the gradual accumulation of a collection of fluid. The fluid content of most hydroceles is straw-colored and odorless.

Hydroceles may also result from trauma, infections, tumors or operations such as a hernia and varicocele repairs. They are evaluated by physical examination and are often further characterized by an ultrasound of the scrotum, allowing for a detailed examination of the underlying testicle that often cannot be provided by physical examination because the size of the hydrocele.

Ultrasonography_of_hydrocele

Ultrasound image, public domain (testes is the ball-like structure that appears gray, hydrocele is the surrounding fluid that appears black)

Most small and moderate size hydroceles that are minimally symptomatic can be managed simply by periodic checkups. If a hydrocele progresses to the point where it causes discomfort, pain, tightness, deformity, or embarrassment, an option is to pass a needle into the hydrocele sac and drain the fluid, but this is most often just a temporary fix, as the root cause is unchanged and the fluid generally will re-accumulate.

The most definitive means of management is a relatively simple outpatient surgical procedure called a “hydrocele repair” or “hydrocelectomy.”  The incision is typically through the midline “seam” of the scrotum; the involved testicle and surrounding hydrocele sac are delivered through the incision, the sac opened, fluid drained and generally the sac is excised and oversewn or alternatively, the opened sac is turned back on itself and sewn to itself.  Either method results in exposing the testes to the scrotal wall (as opposed to the outer layer of the tunica), which functions to resorb the fluid produced by the inner layer of the tunica.  This procedure is a highly successful means of treatment of the hydrocele.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor