0022-5347/95/1546-2 143$03.00/0 THE JoiRNAL OF UROLOGY Copyright 0 1995 by AMERICAN U R O ~ I C A L ~ ~ ~ ~ ~ I A T I O N , hc.

Vol. 164,2143, December 1906 printed in U . S A

Case Report

TORSION OF A SPERMATOCELE ONER ODABW, SABAHAT" AYDIN AND -EL YILMAZ

From the Department of Urn@, Medical School of Yiiziincii Yil University, Van, lbr& KEY WORDS: torsion. spermatocele, teatis

As described by Cavasse in 1860, spermatocele is a reten- tion cyst of the scrotum, which is or has been in communica- tion with the semen carrying system.' The term spermato- cele was first used by Guerin in 1785 to describe an inflammatory condition of the testicle.2 A spermatocele is a cyst filled with fluid and spermatozoa most frequently aris- ing from the vasa efferentia and less commonly from the superior vas aberrans, canal of the epididymis and appendix testis.3

We describe the fourth case of torsion of a spermatocele. However, we think that this condition is considered rare because it is seldom reported. Our aim in reporting this case is to help to demonstrate the actual incidence of this entity.

CASE REPORT

K. O., an 18-year-old man, presented in April 1994 with severe left scrotal pain 4 hours in duration. He had had previous intermittent episodes of mtal pain 2 months in duration. Physical examination revealed 2 ovoid masses in the left hemi-scrotum. Ultrasonography confirmed that the superior mass was the left testicle and showed that the larger inferior mass was a 6.5 x 3.5 cm. paratesticular fluid collec- tion. On palpation the cystic mass was more painful than the testicle. The mass in the left scrotum had been present for years but the patient had not reported pain until 2 months previously. There was no history of trauma or operation. Laboratory data were normal, including complete blood count and urinalysis.

Exploration was done via a vertical left scrotal approach with an initial diagnosis of torsion of the left spermatic cord. The tunica vaginalis was opened and a yellowish tinged, fluid filled cyst was noted with 360 degrees of torsion at the base. The diagnosis was torsion of a large spermatocele. We per- formed detorsion and a large long pedicle became apparent (see figure). The spermatocele was excised and ligated at the pedicle. The testis was returned to the left hemi-scrotum and the incision was closed with chromic catgut. The cyst fluid had numerous spermatozoa and pathological examination of the specimen revealed a spermatocele arising from the epi- didymis.

DISCUSSION

Torsion of a spermatocele on its pedicle is a rare clinical entity that is o h n n&,&en for torsion of the testis, sper-

Accepted for publication May 19, 1995.

Spermatocele after detorsion with large long pedicle

matic cord or testicular appendages, which is common. The first 2 cases of torsion of a spermatocele were reported by Jassie and Mahmood4 and the third by b y e and Cromie.6 These cases mimicked acute testicular torsion and the sper- matocele arose from the head of the epididymides. Patient age was 20,44 and 13 years, and the diameter of the cysta was 2,2.5 and 3 X 5.5 cm., respectively.

The presence of a &tinct pedicle would appear to be a necessity for the occurrence of torsion, as in our case. We suspected torsion of the spermatic cord and were surprised that the cystic mass was painful. We think that this finding might be important in the Merentid diagnosis. We believe that reports of such cases by clinicians would indicate the true incidence of torsion of a spermatocele.

REFERENCES

1. Cavasse, I.: Un point de Pbtoire du spermatocele. Gaz. Hop.

2. Guerin, T.: Observation sur une spermatocele tr&s considerable.

3. Campbell, M. F.: Spermatocele. J. Urol., W. 485,1928. 4. Jassie, M. P. and Mahmd, P.: Torsion of spermatocele: a newly

described entity with two case reports. J. Urol., 139.683,1985. 5. Kaye, R. I. and Cromie, W. J.: Torsion of a spermatocele: a case

report and review of the literature. J. Urol., 143: 786,1990.

Paris, 33: 378, 1860.

J. Med. Mil. Paris, 4: 66,1785.

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