Two large spermatoceles two weeks post-orchiopexy?

[Vivara]

Was working in an after-hours family medicine facility and came across a patient who gave the impression (over the phone) to the triage nurse that he had a large clot (hematocele?) near the right testicle.

Patient is seventeen and had unilateral testicular torsion on the right-side two weeks ago, and was seen to promptly. Record says testicle was close to necrosis but in the end was salvaged. Surgeon performed bilateral orchiopexy.

Two weeks out, he is in little or no pain, except the same day he visits the facility — slight, dull pain is experienced. Patient notices a large mass on right testicle.

Anyway, when I examined him, there was what felt like two very large (large enough to be physically visible) spermatoceles. Spermatoceles which came on within four or five hours. I'm not a urologist and not the most experienced, so I was totally baffled and called the senior family medicine attending who was equally as baffled.

Upon questioning, the patient said he had a wet dream the night previous. Still baffled, although my attending mentions something about the spermatic duct being tied off (in error?). Patient also has a varicocele on the right-side, and history of a minute spermatocele which developed over several months on the left-side and eventually disappeared.

Anyway, we advised him that it seemed non-urgent and to contact his surgeon on Monday.

But my question is... what was this most likely? I'm rotating at an after-hours facility so I have no way of following up. Patients are rarely seen twice. Google brings up nothing related to orchiopexy and rapid-onset spermatoceles, and there seems to be nothing in the journals, either.

Anyone have any thoughts?

---

Members don't see this ad.

 

[felipe5]

hmmm, not sure if I've ever heard of acute onset spermatoceles---in the post operative setting I'd more likely suspect hematomas which can get tense and rather large, especially if hemostasis was not meticulously obtained. If the nut was close to necrotic then persistent non-viability is always a concern as well

Were you able to distinctly palpate the testicle or did it feel like a big mass without discernable landmarks? With spermatoceles you should still be able to feel the testicle as a distince entity but with hydroceles/hematoceles everything gets blurred

Bottom line your rec of gettin him checked out by his urologist is the right thing to do.

 

[Vivara]

If the nut was close to necrotic then persistent non-viability is always a concern as well

How would non-viability present itself post-operatively? And two weeks later?

Were you able to distinctly palpate the testicle or did it feel like a big mass without discernable landmarks? With spermatoceles you should still be able to feel the testicle as a distince entity but with hydroceles/hematoceles everything gets blurred

Yes, the testicle was absolutely palpable as a distinct entity. The testicle felt normal, but it was the masses off the testicle that were not easily discernible. They were oddly-shaped.. it did feel like two spermatoceles, but it could have been one big one that was not perfectly spherical!

It did not feel like a hematocele/hematoma. It definitely felt cystic. But it was not a hydrocele, either.

Neither myself or my attending wanted to say for sure what it was, but when the patient mentioned that he previously had a spermatocele on the left side, we both jumped to say that that's what it felt like. My attending still was not 100 per cent though.

I have a feeling that I could follow this up if I tried as I am again at the facility next week and may be able to phone a colleague at the hospital he had surgery on. We also may get rights to the records with the medical database we have here, too, as it's all linked in to the same network.

You really have never heard of acute onset spermatocele?

 

[felipe5]

You really have never heard of acute onset spermatocele?

no.