Ultrasound follow-up of ethanolamine oleate sclerotherapy for spermatoceles

Although sclerotherapy as a treatment for hydroceles has gained in popularity during the last few years, there is no consensus on whether it can also be adopted for the treatment of spermatoceles. We examine here the efficacy and safety of ethanolamine oleate sclerotherapy in cases of spermatocele using ultrasound (US) before treatment and during follow-up. Thirty-seven consecutive outpatients aged 36-84 years (mean 61) with symptoms of 40 spermatoceles (1-3 chambers) treated by sclerotherapy were included in the series. It is concluded that US allows multilocular spermatoceles to be differentiated from hydroceles. Post-treatment US findings are typical, including heteroechoic masses with cystic areas extratesticularly, hyperechoic lines peritesticularly (thickened tunicas) and a thickened scrotal wall. All lesions are reversible, however. US is helpful when assessing the need for resclerotherapy. Ethanolamine oleate proved to be effective as a sclerosant, as 83% of the cases were cured or became significantly better. Complications were few and there were no changes in the epididymis. Ethanolamine oleate sclerotherapy can be recommended as an alternative treatment to surgery, especially in older patients with spermatoceles consisting of 1-3 chambers.