User:Kmadan/Sperm granuloma

A sperm granuloma is a lump of leaked sperm that appears along the vasa deferentia or epididymides in vasectomized men. Sperm granulomas range in size from one millimeter to one centimeter, but can potentially be larger. They are comprised of a central mass of degenerating sperm surrounded by tissue containing blood vessels and immune system cells. While some sperm granulomas can be painful, most of them are painless and asymptomatic.

The vast majority of sperm granulomas in vasectomized men are present as a result of the pressure-induced changes of vasectomy.

Sperm granulomas can appear as a result of surgery (vasectomy), trauma, or an infection such as sexually transmitted disease.

Treatment and Prevention
Most sperm granulomas are asymptomatic and absorbed over time. However, in more severe cases, non-steroidal anti-inflammatory drugs such as Ibuprofen may be used.

Surgery is very rarely performed. In cases where symptoms do not resolve in a reasonable amount of time and NSAID therapy is ineffective, the provider may choose to surgically resect the nodule where the pain is localized. Additionally, the stumps of the vas deferens can be burned and ligated in order to reduce the pain the patient is experiencing and prevent its recurrence.

Cauterization is a vasectomy method used to seal the vas deferens by utilizing heat or electricity to burn the lumen. Using thermal (heat) cautery instead of electrocautery can help prevent granulomas and nodular thickening.

Refraining from ejaculation for 1 week can potentially reduce the risk of developing a sperm granuloma.

There is also evidence that sperm granuloma formation may be linked to testosterone deficiency. Testosterone supplementation may reduce the inflammation related to sperm granulomas and potentially even prevent them from occuring. However, this evidence is only supported in animal models.

Effects on Sperm Quality and Fertility
It is not fully understood whether sperm granulomas are detrimental to sperm quality and fertility in humans. However, studies in donkeys have shown that sperm quality is only marginally affected. There was a lower percentage of sperm with intact plasma membranes; however, no effect on motility or morphology was observed. The effect on fertility is still unknown.

Diagnosis
Sperm granulomas are diagnosed using histological examination and typically occur within a few weeks of a vasectomy. An example of a histology based diagnosis supporting sperm granuloma would be a sperm core surrounded by inflammatory cells, apoptotic cells, and fibrous tissue. Often, there will be empty tubules with cellular debris near the granuloma.

Sperm granulomas are occasionally mistaken for other conditions, such as testicular tumors. In these instances, a more complicated treatment approach such as an orchiectomy may be accidentally used.

Sperm granulomas may also be mistaken for supernumerary testis (the presence of more than two testes).

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Signs and symptoms:

Sperm granulomas appear as hard and firm nodules that do not exceed 1 cm in size. Sperm granulomas form in 20-50% of vasectomy procedures. An injury to the epididymal epithelium is caused by penetration of germ cells into the epididymal supportive tissue. This infiltration of germ cells allows for the pathogenesis of sperm granulomas. Moreover, the penetration of germ cells leads to inflammatory and autoimmune reactions that further increase the risk of sperm granuloma formation. Sperm granuloma can also mimic supernumerary testis on the ultrasound.

Sperm granulomas are mostly asymptomatic. However, they can cause pain and swelling of the epididymis, spermatic cord, and testis. The pain usually radiate to the groin, the junctional area between the abdominal wall and the thigh, which can imitate kidney spasms.

What causes it?

Sperm granuloma is a common complication of bilateral vasectomy. Vasectomies are a common, effective procedure for sterilization of men. History of trauma or epididymitis can also lead to sperm granuloma. In vasectomies, the vas deferens are cut and the two ends are tied to prevent sperm from passing. Sperm granuloma may then grow at the point where the vas deferens were cut. This could happen two to three weeks post procedure. Sperm granuloma can also form from sperm leaking from the vas deferens into the surrounding interstitium. Leakage of sperm elicits an immune response which can lead to chronic inflammation. To reduce the risk of sperm granuloma from formation, patients can refrain from ejaculation for one week post vasectomy.