Page ContentSpermatoceleSpermatoceles that swell and become painful may require surgical removal.A spermatocele is a normally painless, fluid-filled cyst that forms in the epididymis, which is the long, coiled tube above and behind each testicle. It feels like a smooth, firm lump in the scrotum. The fluid in the cyst may contain nonactive sperm. While most cases do not require treatment, spermatoceles can become painful if they swell and become large. Your doctor may recommend surgery in this instance.SymptomsOther than a small lump, a spermatocele usually causes no signs or symptoms and will remain the same size. If it becomes large enough, however, you might feel pain or discomfort, a feeling of heaviness and/or a large mass behind and above the testicle.CausesThe exact cause of spermatoceles is unknown, but they may be a result of blockage in one of the tubes in the epididymis that store and transport sperm from the testicle. The blockage may occur because of trauma or inflammation.Diagnosis & TreatmentTo diagnose a spermatocele, your physician will palpate the lump and may shine a light through your scrotum to see if the lump is solid or filled with fluid. If this transillumination doesn’t clearly show the cyst’s properties, your doctor may order an ultrasound to rule out a tumor or other cause of scrotal swelling. A spermatocele will not go away on its own, but typically no treatment is required unless the cyst is large enough to cause pain or discomfort. Your doctor will likely begin treatment with an over-the-counter pain reliever. If the pain or discomfort becomes unbearable, you may choose to undergo an outpatient procedure called a spermatocelectomy, in which a surgeon makes an incision in the scrotum to separate the spermatocele from the epididymis. Another possible treatment is aspiration, during which a needle is inserted into the spermatocele and the fluid is removed. If you notice a lump or cyst on your scrotum or testicle and suspect a spermatocele, the urology specialists at Kelsey-Seybold Clinic in Houston can confirm the diagnosis and help you decide whether or not treatment is necessary.