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We report a case of torsion of a spermatocele in an adolescent. This condition has been described previously in adults. We recommend its consideration in the differential diagnosis of the acute scrotum in adolescents.
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.
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.
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.
Six patients with congenital absence of the vas deferens were treated by artificial spermatoceles (ASCs) in an attempt to collect sperm for subsequent artificial insemination (AI). The ASC was constructed from a flap of tunica vaginalis from the patient. Sperm were aspirated from the ASC each month; there was wide variation in the concentration of sperm recovered [33.0 +/- 48.2 x 10(6) mL-1 (range 0.1-200)] and motility and normal morphology of the sperm were 19.0 +/- 17.9% and 48.8 +/- 23.4% respectively. Although a total of 14 cycles of AI was performed using the aspirated sperm, pregnancy did not result. Both poor sperm recovery and poor motility contributed to this failure. The condition of the epididymis observed during scrotum examination is reported. It is suggested that in some patients with congenital absence of vas deferens, the paired Wolffian ducts may differ from each other in their development.
A 47-year-old man developed a presacral mass after abdominoperineal resection, which is combined with pre and postoperative radio-chemotherapy for carcinoma of the rectum. CT-guided biopsy and cytological examination of the mass revealed no malignancy but spermatocele, which is a very unusual complication of rectal surgery.
It is demonstrated in 30 rats that implantation of a cup-shaped silicone prothesis upon the head and the tail of the epididymis can serve as an alloplastic spermatocele. The implantation of six similar protheses upon the epididymis in bulls confirms the results obtained in rats. Spermatozoa aspirated from this prothesis up to 4 months after operation showed good morphology and motility which improved: (1) the earlier they were obtained after surgery, and (2) the nearer the tail of the epididymis, the prothesis was implanted.
Alloplastic spermatocele implants were used for 11 infertile men with bilateral congenital absent vas. Successful recovery of spermatozoa from the prosthesis was obtained in 8 cases for periods up to 4 months after the operation. Single aspirations showed 200,000 to 30 million spermatozoa, and the aspirated volume varied between 0.4 and 1.0 ml. Artificial insemination of the wife was done at the time of ovulation, but no pregnancy has been achieved yet. In only 3 cases the aspirated fluid did not show spermatozoa, which might be due to occlusion of the vasa efferentia or ductus epididymis.
We present a sclerosing treatment with oxytetracycline in 23 patients with hydrocele and 8 with spermatocele. We injected 250 mg of the drug in cases with less than 250 cc of liquid extracted and 500 mg in the others. The cure rate with the first injection reaches 69.5% and absolute failure 13.04%. Complications were 26.08%, consisting of a chemical febrile orchiepididymitis. It is a method for elderly and high-risk patients. It is economical, simple, repeatable and is carried out on an out-patient basis without any need for hospitalization.
Microinjection of capacitated sperm into the perivitelline space of oocytes has been performed in a case of male infertility attributed to excretory azoospermia. In this particular case, a spermatocele detected five years ago was observed, which provide motile spermatozoa. These sperm collected by direct puncture into the cyst, were capacitated using discontinuous Percoll gradient. After ovarian stimulation, seventeen oocytes were collected. Nine of them were used for classical IVF whereas the other eight were submitted to microinjection. Only one oocyte of the second group fertilized and cleaved 48 hours later. A clinical pregnancy was achieved after embryo transfer and a normal, healthy boy delivered at term.
Treatment of hydroceles and spermatoceles with evacuation, followed by injection of the sclerosing agent Polidocanol 3% (Aetoxysklerol), is a simple, low cost alternative to surgery. For the patient, it is also less painful compared to sclerotherapy using tetracycline. This article shows that the long term results are very promising. 28 patients, of whom two were treated for bilateral celes, gave us a total of 30 treatments. We interviewed the patients 62 months (52-67 months) after treatment, and found that in 24 of the 30 treatments there were no sign of relapse. In three cases the patient had noticed a small relapse, but had no pain. Three have later been treated with surgery.
Insemination with the sperm of an epididymal reservoir three days after implantation of the prosthesis led to a successful pregnancy with subsequent delivery of five healthy sucklings. Alloplastic spermatocele can function longer than four months as proved by a successful pregnancy.
In a patient with azoospermia secondary to bilateral agenesis of the vas deferens an artificial spermatocele was constructed from the tunica vaginalis testis. The sperm reservoir has been in place for 14 years with its size and the quality of the aspirated semen unchanged. A total of 70 aspirations performed during this period yielded mean volumes of 0.7 +/- 0.24 ml. with a sperm density of 60 +/- 14.7 million per ml. Sperm morphology was normal and sperm motility, although markedly decreased, responded well to stimulation by a motility enhancer. The patient did not have antisperm antibodies.
Spermatozoa from a patient with an artificial spermatocele (Dardik's prosthesis) implanted onto the vas deferens were found to have high levels of IgG/IgA antibodies absorbed on their surfaces (MAR-test). Pre-treatment of such sperm with Percoll/BMW (d = 1.05) apparently reduced their MAR positivity and improved their ability to penetrate into ZP-free hamster oocytes or into the oocytes of the wife, respectively.
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