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A sperm granuloma is an infection caused by sperm leaking into the scrotum during a vasectomy or vasectomy reversal. Successful reversal is more likely when there has been a granuloma following vasectomy. Those who have had a granuloma following a vasectomy reversal frequently have sperm antibodies, but these have not been shown to affect fertility.
The granuloma is formed when sperm leaks out of the damaged vas defrans, which is the cord that carries sperm from the testicles. An immune response happens, and the sperm is surrounded by a protective mass. Many cases cause no symptoms, but of those that do, the most common is radiating pain in the groin. Cases of sperm granuloma usually resolve without treatment, although pain can last for up to a year.
This type of infection occurs in approximately 35% to 42% of vasectomies, and troubling symptoms occur in approximately 3% to 5% of these cases. Symptoms typically occur two to three weeks after surgery. Although granulomas are common following vasectomy and reversal, any palpable lump should be checked by a healthcare professional to rule out testicular cancer.
When treatment is necessary, steroids injected into the mass usually resolve the problem. If the steroids do not work, the mass may need to be surgically removed, although this is usually viewed as a last resort.
Vasectomies are usually performed in a doctor's office or in a surgery center as an outpatient procedure. Local anesthetic is used, and the procedure lasts 20 to 30 minutes. A hole or incision is first made in the scrotum, then part of the vas defrans is pulled through and either clipped or cauterized. The incision is then stitched, but if a hole was used it, will not need stitches.
A vasectomy reversal is done either in a surgery center or a hospital. General anesthesia may be used, although a local anesthesia or an epidural are sometimes given instead. The most common method is to reattach the cut end of the vas defrans. Occasionally, the vas defrans is attached to the epididymis, a coiled cord that connects the testicles to the vas defrans, instead.
Rarely, a sperm granuloma may occur following rupture of the epididymis. Rupture is usually associated with injury, and is a medical emergency. Testicular torsion can cause the epididymis to swell and eventually burst. This usually occurs following injury, and causes extreme pain and swelling of the testicle.