Comprehensive Urology

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The daVinci System

Delta Medix Patient General Information

Spermatocelectomy & Excision of an Epididymal Cyst

Definition

Spermato = pertaining to sperm

Cele = balloon-like

Epididymis = a small organ attached to the testicle that stores spermEctomy = removalExcision = to cut away

The epididymis is a small organ that drapes over the back of each testicle. In the epididymis, sperm undergo some changes and are stored. A cyst can develop in one of the ducts and enlarge. A cyst is a benign (not cancerous or malignant) balloon-like structure that contains fluid. Many men have epididymal cysts, but rarely do they present a problem. In rare instances, a cyst can grow quite large and cause discomfort. In these cases, a patient may elect to have it removed.

A spermatocele is also a benign balloon-like structure, but one that contains sperm. It is a weakening in the wall of one of the sperm tubules in the epididymis. It grows most commonly on the upper portion of the epididymis. Like cysts of the epididymis, they are quite common but rarely present a problem. Some can grow to be quite large and cause discomfort. In these cases, a patient may elect to have it removed.

Both of these are often discovered by a patient during self-examination or while washing. Unless they are large, it is very unusual for either to cause discomfort. Others are detected by a physician during a routine examination. Many are not felt but are found during an ultrasound of the scrotum/testicles being performed for an unrelated reason.

Occasionally it may be difficult to differentiate a large spermatocele from a large epididymalcyst on physical examination. Even with the addition of an ultrasound examination, it is not always clear which exists. Regardless, the surgical procedure to remove either is quite similar and so differentiation is not usually necessary.

Preparation

As with any procedure in which anesthesia is administered, you will be asked not to eat or drink anything after midnight on the evening prior to your surgery. you may brush your teeth in the morning but not swallow the water. If you are on medications that must be taken, you will have discussed this with us and/or the anesthesiologist and instructions will have been given to you. the procedure will not be performed if you are currently on, or have recently taken any medication that may interfere with your ability to clot your blood ("blood thinners, aspirin, anti-inflammatory medicines, etc.").

The most common of these medications are aspirin and all related pain relievers or anti-inflammatory compounds (whether prescription or over-the-counter).Please refer to the attached list and tell us if you took any of these within the past 10 days. If your new medication is not on the list, alert us immediately so that we may ensure optimal procedure safety. We will have reviewed all of your current medications with you during the pre-operative/pre-procedure consultation. You are obligated to inform us if anything has changed (medication or otherwise) since your previous visit.

We will insist that you have a good quality scrotal support (jock strap) or a good pair of jockey shorts ready at home. You may be asked to wear them for a couple of weeks after surgery. Support helps to reduce discomfort and swelling.

Procedure

To review what we discussed in the office: Most of these procedures are performed with general anesthesia (complete sleep). Other types of anesthesia can be arranged between you, your surgeon, and the anesthesiologist. The procedure usually takes one to two hours or less depending on an individual's anatomy and whether prior procedures have been performed in the scrotum.

An incision is made in the scrotum. The incision can be up and down, left to right, in the midline of the scrotal sac, or off to one side depending on your surgeon's preference for your particular case. Dissection is then performed down to the testicle and epididymis. Usually, the entire testicle is delivered out of the incision so that the extent of the cyst or spermatocele and all of the anatomy can be carefully examined. The balloon-like cyst or spermatocele is then dissected away from the epididymis while preserving as much of the epididymis as possible. Sometimes, a portion of the epididymis or even the entire epididymis must be removed because separating the two may cause too much bleeding or damage to other structures. Once the cyst or spermatocele is removed, the incision is sutured closed.

Post Procedure

You will be in the recovery room for a short time before being sent home. You may have discomfort over the incisions and possibly in the groin and scrotum. There may be a scrotal support with some gauze underneath. There may be no dressing directly adherent to the incision and so the stitches may be visible. Sometimes, you will notice a white glue-like substance over the incision. Occasionally there is small blood staining on the gauze or skin, and this is normal. If the dressing becomes soaked, or you see active blood oozing, please contact us. You may shower the day after surgery, but no baths or swimming. Some surgeons may recommend warm baths a couple of times per day a few days after your surgery. We ask that you refrain from any strenuous activity until your follow-up. Every patient has some degree of swelling and bruising, and it is not possible to predict in whom this might be minimal or significant. We may recommend that you apply ice compresses to the scrotum when you return home. We strongly encourage you to take the following day off of work and perhaps more if your occupation requires strenuous activity or heavy lifting. In the first 24hours, it is to your advantage to minimize activity and spend a lot of time lying down. The more swelling you prevent in the first two days, the better off you are. Some patients have almost no discomfort while others are somewhat uncomfortable for a few days. We may provide you with a prescription for pain medication but you certainly may take an over-the-counter medication to which you are not allergic. Upon you follow-up in the office, we will examine you. The sutures we use are self-dissolving, and therefore just fall out on their own within two to three weeks after surgery.

Expectations of Outcome

The tissues within the scrotum always swell and usually feel quite firm to the touch after swelling begins. The scrotal skin may appear very bruised as well. This is expected, and could last for a few weeks.

The tissue removed is usually sent to a pathologist (doctors that examine tissue under amicroscope) for review. During the surgery, however, we can typically tell whether the mass is a spermatocele or cyst. Regardless, no further treatments are necessary. To hear anything different from the pathologist is extremely uncommon.

*As mentioned previously, it is sometimes necessary to remove a part of or even the entire epididymis when excising a spermatocele or even a cyst. Large size, complexity of the mass or prior infection will increase the likelihood.

Removal of a spermatocele can cause obstruction of the flow of sperm through the epididymis on that side. Although fertility is no longer a concern to the majority of patients undergoing these procedures, it can be an issue in younger men.

Possible Complications of the Procedure

ALL surgical procedures, regardless of complexity or time, can be associated with unforeseen problems. They may be immediate or even quite delayed in presentation. While we have discussed these and possibly others in your consultation, we would like you to have a list so that you may generate questions if you are still concerned. We think it is important that every patient be made aware of all possible outcomes. "An educated patient is the best patient."
Recurrence or Persistence: A spermatocele or cyst may uncommonly return. It is almost always a new process and not recurrence of the already removed mass.

  • Hematoma: This is when a blood vessel continues to ooze or bleed after the procedure is over. The result is greater swelling and bruising. It usually resolves overtime with compresses...much like any bad bruising or swelling. If the hematoma is unusually large (cumbersome or painful) or does not show resolution in a reasonable amount of time, a procedure to evacuate the clots may be required.
  • Infection: Infection is possible in any procedure. Usually, local wound care andantibiotics are sufficient. Occasionally, an infection would require partially opening the wound to allow proper drainage.
  • Chronic Pain: As with any procedure, a patient can develop chronic pain in an area that has been operated on. Typically, the pain disappears over time. If persistent, further evaluation would be necessary.
  • Testicular Ischemia/Loss: This is quite unlikely, but could occur from loss of blood flow to the testicle.

We provide this literature for patients and family members. It is intended to be an educational supplement that highlights some of the important points of what we have previously discussed in the office. Alternative treatments, the purpose of the procedure/surgery, and the points in this handout have been covered in our face-to-face consultation(s).

The information contained in this document is intended solely to inform and educate and should not be used as a substitute for medical evaluation, advice, diagnosis or treatment by a physician or other healthcare professional. While Delta Medix endeavors to ensure the reliability of information, such information is subject to change as new health information becomes available. Delta Medix cannot and does not guaranty the accuracy or completeness of the information contained in this document, and assumes no liability for its content or for any errors or omissions. Please call your doctor if you have any questions.

Delta Medix, P.C.