Although your spermatocele probably won't go away on its own, most spermatoceles don't need treatment. They generally don't cause pain or complications. If yours is painful, your doctor might recommend over-the-counter pain medications, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others).
A procedure called a spermatocelectomy generally is performed on an outpatient basis, using a local or general anesthetic. The surgeon makes an incision in the scrotum and separates the spermatocele from the epididymis.
After surgery, you might need to wear a gauze-filled athletic supporter to apply pressure to and protect the site of the incision. Your doctor might also tell you to:
- Apply ice packs for two or three days to keep swelling down
- Take oral pain medications for a day or two
- Return for a follow-up exam between one and three weeks after surgery
Possible complications from surgical removal that might affect fertility include damage to the epididymis or to the tube that transports sperm (vas deferens). It's also possible that a spermatocele might come back, even after surgery.
Aspiration, with or without sclerotherapy
Other treatments include aspiration and sclerotherapy, though these are rarely used. During aspiration, a special needle is inserted into the spermatocele and fluid is removed (aspirated).
If the spermatocele recurs, your doctor might recommend aspirating the fluid again and then injecting an irritating chemical into the sac (sclerotherapy). The irritating agent causes the spermatocele sac to scar, which takes up the space the fluid occupied and lowers the risk of the spermatocele coming back.
Damage to the epididymis is a possible complication of sclerotherapy. It's also possible that your spermatocele might come back.
Protecting your fertility
Surgery can potentially cause damage to the epididymis or the vas deferens, and sclerotherapy might damage the epididymis, which can affect fertility. Because of this concern, these procedures might be delayed until you're done having children. If the spermatocele is causing so much discomfort that you don't want to wait, talk with your doctor about the risks and benefits of sperm banking.