Spermatocele

SPERMATOCELE (seminal cyst), a name given by Morgagni, indicating that the fluid contained within the cyst is mixed with the secretion of the testicles. Hochenegg found S. in 20% of cases during autopsies, and only in individuals who had reached sexual maturity. The starting points of a spermatocele are various. It has been established that this involves a cystic dilation of altered seminal tubules. S. develop during abnormal embryonic development, most often from the Morgagni hydatids [ductus aberrans (vasa aberrantia) or paradidymis (organ of Giraldes)]. From all these formations, which end blindly but are connected to the seminal tubules, S. can form. A spermatocele can also develop as a result of trauma or an inflammatory process if narrowing or obliteration occurs along the course of the spermatic cord or the canal of the epididymis, resulting in the retention of secretion and subsequent cystic dilation. The wall of an S. consists of connective tissue and a layer of epithelium, and it exhibits chronic inflammatory proliferative changes. The cystic fluid is transparent, yellowish-green in color, with a specific gravity of 1.020, and an alkaline reaction; when the specific gravity is below 1.009, it has a neutral reaction. Sometimes the external appearance of the contents resembles a soapy liquid, more rarely a milky-colored one. In the latter case, the S. is called a galactocele. The spermatic fluid contains epithelium, leukocytes, fat droplets, spermatocytes, and spermatozoa; the latter are often normal, actively motile, and sometimes retain their viability outside the organism for several days. Upon clinical examination, an S. appears as a uniform, slowly growing, often fluctuating tumor, which is painless upon palpation. It is of moderate size—from a pea to a small apple; in individual cases, it can reach the size of two fists (Kocher). Painful sensations occur when the scrotum enlarges; patients feel pressure in the testicle, scrotum, and inguinal region, which intensifies during sexual arousal. Two groups of spermatocele are distinguished depending on their location outside or inside the tunica vaginalis of the testicle: intravaginal and extravaginal. In the intravaginal form, the testicle is found in its normal place, and at the head of the epididymis, there is a roundish or egg-shaped fluctuating tumor; sometimes, however, an S. can spread anteriorly and downward, bulging the visceral layer of the tunica vaginalis of the testicle. In the extravaginal form, the cyst is located posteriorly and superiorly to the testicle. A large size of the cyst can place the testicle in the direction of the horizontal axis. Conservative treatment, consisting of draining the fluid, does not yield results, and a recurrence occurs. The most radical path is operative, consisting of total extirpation of the S. through an incision directly over it or in the inguinal region. In cases of adhesions with the tunica albuginea of the testicle, a partial resection of the head of the epididymis is sometimes required.

M. Zaigraev. - SPERMATURIA, the presence of spermatozoa in the urine. Normally, spermatozoa are found in the urine after coitus or a nocturnal emission. Pathologically, S. is observed in two forms: 1) in spermatorrhea (see), 2) in the presence of an obstruction to the discharge of semen along the course of the urethra (mainly pronounced degrees of narrowing of the latter). During coitus, the semen is thereby completely or partially retained behind the narrowing, enters the urinary bladder, and is then discharged with the urine during urination. Treatment consists of eliminating the cause of the disease.