What is a sperm granuloma?
The funiculus spermaticus is a bundle of nerves, blood vessels and the male spermatic duct measuring around 20 centimeters. The anatomical structure is also known as the spermatic cord and runs through the male inguinal canal. In sperm granuloma, the spermatic cord changes to nodular hard consistency.
Spermatozoa emerge in a sequence into the surrounding tissue. Sperm granulomas are often discovered as part of an autopsy. These incidental findings affect about three percent of all men. An incidence of up to 40 percent have the changes in the male group with vasectomy. Basically, the phenomenon is a spermatic cord disease, which usually shows no manifest symptoms.
The only symptom is the palpation. A pressure sensitivity in the range of the change is possible, but does not necessarily have to be present. Like all other granulomas, the sperm granuloma is an inflammation-related nodular neoplasm of epitheloid cells, mononuclear cells or giant cells. The benign change is usually the result of chronic, allergic or infectious processes.
The primary cause of sperm granulomas may be most common in a vasectomy performed on the spermatic cord during sterilization. The surgical procedure of sterilization injures the vas deferens. Sometimes there are also injuries to the epididymis. These injuries cause spermatozoa to enter the surrounding tissue.
Sperm granuloma does not always have to be associated with a vasectomy. Also, inflammatory reactions may injure the epididymis and the spermatic cord and favor the escape of spermatozoa. The entry of the spermatozoa into the tissue is the cause of every sperm granuloma. The spermatozoa carry a dense and enzymatically difficult to degrade DNA, which is surrounded by an acid-resistant shell.
Due to this structure, they survive in the milieu of the female sex organs. The individual components of the spermatozoa, especially the ceroid pigment, stimulate the immunological macrophages on exit from the epididymis.
The immune cells become epithelial cells and thus promote the formation of a granuloma. Macroscopically, sperm granulomas are brown nodes of small size, which in the histological picture correspond to the foreign body type and consist of epithelioid cells as well as giant cells.
Symptoms, complaints & signs
Men with sperm granuloma suffer from a nodular hard change in the area of the spermatic cord. In many cases, sufferers feel the tissue change themselves and seek the doctor with the suspicion of a malignant change. In other cases, the granuloma is so small that it is not noticed by the patient.
Since the granulomas often cause no concomitant symptoms, sperm granulomas can remain permanently unnoticed. Some men with sperm granuloma complain of stress-related pain, especially pressure pain. However, the pressure pain is not a mandatory symptom and can thus be absent despite existing granuloma. Slight pain is common in inflammatory sperm granulomas.
In the case of granulomas following a vasectomy, the pain is already present due to the vasectomy, so that the patients attribute the pain of the granuloma to the backward operation. Accordingly, many sperm granulomas are a chance finding, which is only identified in a different type of examination.
Diagnosis & disease course
For a doctor, the sperm granuloma is usually palpable. If pressure pain exists in the hardened area, suspicion of the granuloma is close. Nonetheless, tumors must be considered in differential diagnosis.
To ensure the diagnosis and to exclude a malignant change, the doctor therefore usually takes a tissue sample, which shows in histology the above-mentioned image of giant and epithelial cells. The prognosis for sperm granulomas is favorable. Often, no intervention is required.
In many cases the sperm granuloma is discovered only very late. This case occurs especially when the node is still very small and thus can not be felt by the patient. Furthermore, the sperm granuloma does not cause any special symptoms, so that the disease often remains undetected for a long time. Other sufferers suffer from pressure pain, although the pressure pain can often occur in normal cases.
Sperm granuloma does not necessarily lead to complications. In some cases, it can also disappear on its own, so that no surgical intervention is necessary. However, many sufferers suspect behind the sperm granuloma of a malignant tumor and can thereby suffer from mental discomfort or depression. In the treatment itself, usually no complications occur as well.
A simple surgical procedure removes sperm granuloma. Even after successful treatment, sperm granuloma may recur, requiring re-treatment. The life expectancy of the person affected is not reduced by the disease. The surgery involves the usual risks and side effects of such surgery.
When should you go to the doctor?
A sperm granuloma must always be treated by a doctor. Since it can be a degeneration and in the worst case a malignant tumor, it should always be treated by a doctor. This can lead to the death of the person affected, if the tumor spreads to other regions of the body. The earlier the sperm granuloma is detected and treated, the better the further course of this complaint.
A doctor should be consulted if the affected person suffers from changes to the tissue on the testicles. In many cases, there is also pain in the testicles, which occur permanently and do not disappear on their own. In many cases, sperm granuloma is discovered by accident. For this reason, regular examinations of this area are very important. If mild pain or tissue changes occur, seek medical attention immediately.
Sperm granuloma can be detected and treated by a urologist or dermatologist.
Treatment & Therapy
Sperm granulomas are harmless and usually cause no discomfort. In many cases, regression of the granuloma takes place after some time. Therefore, there is never an immediate intervention after diagnosis. The doctor waits for some time, so that the granuloma can regress by itself. Every operation puts a strain on the organism of the patient.
Therefore, the surgical removal of a sperm granuloma occurs only in exceptional cases. The affected area is opened during the operation. The tissue regeneration is usually completely removed. Since a biopsy already takes place within the framework of the diagnosis, the removal of the entire granuloma often takes place within the framework of this first tissue sample.
Remnants of sperm granuloma can usually remain in the body without promoting recurrence. In most cases, the leftover remnants are fully recovered. The likelihood of malignant degeneration is relatively low in granulomas. Therefore, there is no acute excision pressure in sperm granulomas.
The fact that affected men usually still opt for an excision, is mainly due to the unpleasant hardening and the sometimes occurring pressure pain. The operation is usually done under local anesthesia.
Especially in the context of a vasectomy Spermagranulomen is hardly to be prevented. However, the experience and quality of work of the sterilizing physicians can minimize the risk of occurrence of complications.
Therefore, the conscientious selection of the operator before the vasectomy in the broadest sense can be described as a precautionary measure. Inflammatory granulomas can be prevented even less than sterilization-related sperm granulomas.
In a sperm granuloma sufferers are usually only a few and only limited measures of a direct follow-up available. For this reason, should ideally be very early to contact a doctor and also initiate treatment so that it does not come to complications or other complaints in the further course. As a rule, a sperm granuloma can not achieve independent healing, so visiting a doctor is always necessary for this disease.
Most sufferers are dependent on surgery in order to relieve the symptoms permanently and usually completely. In doing so, the patient should definitely rest and look after the procedure, whereby efforts or stressful and physical activities should be foreseen so as not to burden the body unnecessarily. Similarly, partner support is very important in many cases to prevent depression and other mental health problems. The sperm granuloma usually does not reduce the life expectancy of the person concerned.
You can do that yourself
If men choose to perform a vasectomy, they should be well informed in advance about the procedure and possible complications of the procedure. The risks of sterilization are to be learned early so that surprises are avoided. The procedure is basically only to be done by a specialist and should not take place abroad. Without a trained medical professional, no changes should be made to the organism, as health problems and complications can occur.
In case of abnormalities in the healing process or other disorders, consultation with the attending physician is required. Self-healing measures are not sufficient in this case. Likewise, there are no alternative healing methods that lead to a complaint. Overreaction to the developments should be avoided and the emergence of internal stress should be prevented whenever possible. The states of emotional stress exacerbate the overall situation and can contribute to worsening. Therefore, the cooperation with a doctor is important to at the same time the person concerned should take care of his own well-being.
An inner restlessness or irritation is not conducive to the overall process. Cognitive training or relaxation techniques help in dealing with and coping with the disease. They can be used by the affected person on his own responsibility in stressful moments.