A 40-year-old man with testicular torsion and large bilateral spermatoceles

Abstract

Testicular torsion is a rare disease that mostly involves children. Peak incidence is in infancy and in adolescence. Testicular torsion is rarely seen in men over 40 years of age and has only once been accompanied with spermatocele. We report the case of a 40-year-old man with testicular pain one day prior to visiting our clinic. The patient's visit to the clinic was delayed due to history of occasional testicular pain related to his bilateral spermatoceles. On arrival, a color Doppler ultrasound test was performed, which revealed heterogeneous echo in the right testis with no vascular flow, suggestive of torsion, as well as two cystic lesions in the right and left scrotums indicating spermatoceles. The patient was immediately transferred to the operating room where the bilateral spermatoceles were resected and after detorting, the right testis was saved. After four months, a normal left testis along with partial right testicular atrophy was observed. It is highly recommended to educate patients with spermatocele who have no indication for surgical treatment to visit their physician in case any new testicular pain is experienced. Furthermore, testicular pain regardless of the co-existing pathology may always be treated as an indicator of suspected torsion.

A Post-Aspiration Giant Spermatocele in a Young Man: A Case Report and Literature Review

“…A search of the PubMed database for articles in English on this subject matter could yield 9 cases of giant spermatoceles. 3 - 11 A giant spermatocele is usually single and unilocular, just like the one in the present case report. However, bilateral 5 , 10 multilocular 3 , 5 , 6 spermatoceles have been reported in the literature.…”

“… 3 - 11 A giant spermatocele is usually single and unilocular, just like the one in the present case report. However, bilateral 5 , 10 multilocular 3 , 5 , 6 spermatoceles have been reported in the literature. Six of the reported cases of giant spermatoceles occurred in men above 40 years 3 , 5 - 8 , 11 unlike our patient.…”

“… 13 Surgery is usually recommended when the diameter of the spermatocele reaches 4 cm and if it is associated with symptoms that cause the patient discomfort, such as cosmetic concerns or scrotal pain (as is the case in the present report) or if there is an associated hernia or hydrocele. 3 - 11 , 23 Surgery is also indicated if a neoplastic pathology cannot be ruled out. Adenocarcinoma of the rete testis has been reported in the literature.…”

“… 24 Some cases may present with soft scrotal swellings, 24 which was the case in the patient in this case report. In giant spermatoceles, surgery is also advisable because the torsions of the testis 10 and the cyst itself around its pedicle 4 , 9 are documented possibilities. Takimoto et al 4 tried to explain the occurrence of testicular torsion in such cases.…”

“…1 , 2 It infrequently gets big enough to bother the patient, be associated with scrotal heaviness, raise suspicions of neoplasm, or necessitate treatment. 3 - 11 This condition is typically insidious and its diagnosis is incidental; therefore, its true incidence has not been documented yet. However, spermatoceles are common as some authors reported an incidence of 30% in men who underwent scrotal sonographic scanning for different reasons.…”