Treatment of Large Asymptomatic Spermatocele in an Elderly Male
For an elderly male with a large, painless spermatocele, observation with reassurance is the appropriate management—no intervention is needed unless symptoms develop.
When Treatment is NOT Indicated
- Asymptomatic spermatoceles do not require surgical correction, regardless of size. 1
- The indication for spermatocele treatment is based on whether the lesion causes impairment to the patient—asymptomatic findings discovered on ultrasound should be left alone. 1
- Spermatoceles are benign cystic dilations of the epididymis that can be safely observed when they cause no symptoms. 2
When Patients Typically Seek Treatment
- Men tolerate spermatoceles for an average of 48 months before seeking intervention. 2
- Patients typically request surgery when spermatoceles reach approximately 4.2 cm in diameter (roughly the size of a normal testicle) AND cause both pain and mass sensation. 2
- Most men (58%) who undergo spermatocelectomy do so due to a combination of pain and sensation of mass, not mass alone. 2
- Pain as an isolated symptom prompts earlier intervention, with affected men being approximately 10 years younger than those bothered primarily by mass effect. 2
Surgical Considerations if Symptoms Develop
- In elderly men, fertility preservation is not a concern, which simplifies the decision-making if surgery becomes necessary. 1
- In younger men, the wish for children must be considered, as spermatocele resection may lead to epididymal obstruction and infertility—but this is irrelevant in elderly patients. 1
- Surgical excision involves scrotal exploration with removal of the cyst emerging from the head of the epididymis. 3
Important Clinical Caveats
- Aspiration of spermatoceles should be avoided—it provides only temporary relief and the lesion invariably recurs, sometimes becoming even larger. 3
- A 27-year-old man developed a giant spermatocele following aspiration that persisted for several years, demonstrating that aspiration is not definitive treatment. 3
- Bilateral spermatoceles can occur and may grow quite large (up to 65 mm) without affecting fertility, as demonstrated in a 45-year-old man who fathered three children despite bilateral multilocular spermatoceles. 4
Recommended Management Approach
- Reassure the patient that this is a benign finding requiring no treatment. 1
- Advise the patient to return if symptoms develop, specifically pain, significant discomfort, or cosmetic concerns that impact quality of life. 3, 2
- No follow-up imaging is needed for stable, asymptomatic spermatoceles. 1
- Document the finding and ensure the patient understands the benign nature of the condition. 1