Spermatocelectomy with and without epididymectomy: retrospective experience at a single institution in patients not interested in fertility preservation.

INTRODUCTION: Spermatocelectomy is a surgical procedure performed for symptomatic spermatoceles. Published data is limited with respect to recurrence rates, complication rates, and patient satisfaction. The core concept of spermatocelectomy is to identify the communication between epididymis and spermatocele, which can be difficult and may result in spermatocele recurrence. We postulate that a combined spermatocelectomy with epididymectomy will yield a lower rate of recurrence.

METHODS: A retrospective chart review of patients with symptomatic spermatoceles undergoing spermatocelectomy with or without epididymectomy at our institution was performed. Patients were excluded from epididymectomy if they were interested in fertility preservation. Patient demographics, operative characteristics, and rates of recurrence and re-intervention were collected.

RESULTS: From 2013 to 2023, 70 patients underwent spermatocelectomy from a total of 14 surgeons, 35 (50%) of which underwent concurrent epididymectomy. A total of 10 (14.3%) patients experienced a recurrence and 5 (7.1%) patients required re-intervention with aspiration or re-excision over a median follow-up of 3.5 months. Patients who underwent spermatocelectomy alone were significantly more likely to experience recurrence (p = 0.006).

CONCLUSION: Current data is lacking regarding recurrence rates after spermatocelectomy. Spermatocelectomy with epididymectomy resulted in a lower recurrence rate than spermatocelectomy alone. Removing the source of the communication between spermatocele and epididymis may result in a lower recurrence rate. A prospective, randomized trial is recommended to confirm these findings.