Dr. Duong Quang Huy, Head of Andrology at Tam Anh General Hospital - District 8, reported that Hoang experienced repeated episodes of hematospermia (blood in semen). Semen analysis revealed azoospermia (absence of sperm) due to inflammation in the reproductive organs, causing blockage of the vas deferens. Hoang also had an epididymal cyst measuring approximately 3x2 cm, nearly the size of a testicle, which had been causing pressure and pain for years.
Hoang also suffered from bilateral varicocele, increasing scrotal temperature and causing blood stasis, which impaired sperm production. Dr. Huy recommended a "4-in-1" surgery to address all issues simultaneously: varicocelectomy, vasovasostomy (reconnecting the vas deferens), cyst excision, and sperm retrieval for in vitro fertilization (IVF).
Using a microsurgical microscope with 30x magnification, Dr. Huy excised the cyst completely without damaging the epididymis or vas deferens. Fluid was then extracted from the epididymis near the connection point using a specialized needle to retrieve sperm for transfer to the lab. Two healthy sperm samples were successfully collected and cryopreserved for IVF.
Next, the blocked section of the vas deferens was identified, removed, and the two ends were rejoined to restore patency and enable natural conception. Finally, the dilated veins causing the varicocele were identified and ligated to prevent backflow, while preserving the arteries and lymphatic vessels to optimize future sperm production.
Hoang was discharged the following day. He was advised to follow a healthy diet, avoid alcohol, tobacco, and stimulants, manage his weight, and exercise regularly to improve blood circulation and reduce stress. He was also encouraged to maintain regular intercourse (every 2-3 days) to prevent sperm stasis and ensure optimal sperm quality during his wife's ovulation period. Six months after the surgery, Hoang and his wife conceived naturally.
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Dr. Huy (far left) performing Hoang's surgery. Photo: Tam Anh General Hospital - District 8 |
Dr. Huy (far left) performing Hoang's surgery. Photo: Tam Anh General Hospital - District 8
Epididymal cysts are fluid-filled sacs in the epididymis, mostly benign. Small cysts often present no symptoms and don't affect fertility or sexual function, requiring no intervention. Larger cysts, however, can cause scrotal discomfort, pressure, and potentially compress the vas deferens and blood vessels supplying the testicles. If left untreated, this can lead to testicular atrophy, permanently impairing sperm production, or cause blockage of the epididymis and vas deferens.
Some infected cysts, if ruptured, can cause widespread infection in the male genital area. Dr. Huy advises men experiencing pain or discomfort in their genitals to seek medical attention promptly to ensure timely diagnosis and treatment, preventing complications and potential infertility.
Dinh Lam
*The patient's name has been changed.
