Comparison of outcomes and costs of surgery versus sclerotherapy to treat hydrocele / Comparação entre resultados e custos de cirurgia e de escleroterapia para tratamento de hidrocele

ABSTRACT Objective: To evaluate the outcomes and costs associated with surgery versus sclerotherapy as treatment of hydroceles. Methods: A total of 53 men consecutively treated for hydrocele at our organization, between December 2015 and June 2019, were retrospectively analyzed (39 with Jaboulay technique and 14 with sclerotherapy). All charts were reviewed, assessing clinical data, ultrasound findings, surgical data, and post-procedure outcomes. The hospital finance department calculated the cost of outpatient evaluation, complementary tests, supplies, drugs, and professionals' costs throughout all procedures. Results: The median age for both groups was similar (58 and 65 years old). Comorbidities were less frequent in the Surgery Group (20; 51%) than in the Sclerotherapy Group (14; 100%, p<0.05). The median length of hospital stay was 34.5±16.3 hours for the Surgery Group and 4 hours for the Sclerotherapy Group. The mean follow-up period was similar for both groups (85.4±114.8 days after surgery, and 60.9±80.1 days after sclerotherapy, p=0.467). No significant complications occurred in any patient. Success rates were 94.8% after surgery and 92.8% after sclerotherapy. The mean cost per patient was US$2,558.69 in the Surgery Group (Hydrocelectomy Group) and US$463.58 in the Sclerotherapy Group (p<0.0001). Costs directly related to in-hospital treatment procedures were significantly higher for surgery versus sclerotherapy (US$2,219.82±US$1,629.06 versus US$130.64±US$249.60; p<0.0001). Conclusion: Sclerotherapy is an excellent treatment option for idiopathic hydrocele as compared to traditional Jaboulay. It has a high success rate, low complication rates, fast discharge and patients return quicker to activities of daily living.

RESUMO Objetivo: Avaliar resultados e custos associados à cirurgia e à escleroterapia como tratamentos das hidroceles. Métodos: Foram tratados consecutivamente para hidrocele em nossa instituição 53 homens, entre dezembro de 2015 e junho de 2019, os quais foram analisados retrospectivamente (39 pela técnica de Jaboulay e 14 por escleroterapia). Todos os prontuários foram revisados, avaliando dados clínicos, achados de ultrassom, dados cirúrgicos e desfechos pós-procedimento. O departamento financeiro do hospital calculou o custo da avaliação ambulatorial, dos exames complementares, dos insumos, dos medicamentos e dos profissionais em todos os procedimentos. Resultados: A idade mediana foi semelhante nos dois grupos (58 e 65 anos). Comorbidades foram menos frequentes no Grupo Cirurgia (20; 51%) do que no Grupo Escleroterapia (14; 100%; p<0,05). O tempo mediano de internação hospitalar foi 34,5±16,3 horas para o Grupo Cirurgia e 4 horas para Grupo Escleroterapia. O período médio de seguimento foi semelhante nos dois grupos (85,4±114,8 dias após a cirurgia e 60,9±80,1 dias após escleroterapia; p=0,467). Nenhuma complicação significativa ocorreu nos pacientes. As taxas de sucesso foram de 94,8% após a cirurgia e 92,8% após a escleroterapia. O custo médio por paciente foi de US$2,558.69 para Grupo Cirurgia e US$463.58 para Grupo Escleroterapia (p<0,0001). Os custos relacionados aos procedimentos de tratamento hospitalar foram significativamente maiores para cirurgia em relação à escleroterapia (US$2,219.82±US$1,629.06 versus US$130.64±US$249.60; p<0,0001). Conclusão: A escleroterapia é uma excelente opção de tratamento para hidrocele idiopática em comparação com a tradicional Jaboulay. Apresenta alta taxa de sucesso, baixas taxas de complicações e alta rápida, além de os pacientes retornarem mais rapidamente às atividades diárias.

Sclerotherapy of hydroceles and spermatoceles with alcohol: results and effects on the semen analysis

PURPOSE: To evaluate the success rates of sclerotherapy of the tunica vaginalis with alcohol for the treatment of hydroceles and/or spermatoceles, as well as, evaluation of pain, formation of hematomas, infection and its effects in spermatogenesis . MATERIALS AND METHODS: A total of 69 patients, with offsprings and diagnosis of hydrocele and/or spermatocele, were treated during the period from April 2003 to June 2007. Semen analysis was obtained from patients who were able to provide us with samples. The sclerotherapy with alcohol at 99.5 percent was undertaken as outpatient procedure. RESULTS: The average volume drained pre-sclerotherapy was 279.82 mL (27 to 1145). The median follow-up was 43 months (9 to 80). A total of 114 procedures were performed on 84 units, with an average of 1.35 procedures / unit and an overall success rate of 97.62 percent. Of the 69 patients, 7 (10.14 percent) reported minor pain immediately after the procedure, 3 (4.35 percent) moderate pain and 2 (2.89 percent) intense pain. Post-Sclerotherapy spermograms revealed reduction of the parameters regarding: concentration, motility and morphology up to 6 months post procedure , with return to normal parameters 12th months after procedure. CONCLUSIONS: Sclerotherapy of hydroceles and spermatoceles with 99.5 percent alcohol is an efficient procedure that can be perormed without difficulties, cost-effectiveness, with few side effects and which may be performed in patients who wish fertility.

Hydrocele; surgery vs. sclerotherapy

A hydrocele is an abnormal collection of serous fluid within the tunica or processes vaginalis. It is treated by surgery and sclerotherapy. To compare the results of surgery and sclerotherapy in the treatment of scrotal hydrocele. Randomized control trial. Department of Surgery, Allied Hospital, Faisalabad; Period: April 2001 to March 2002. 50 consecutive male patients with provisional diagnosis of hydrocele. Patients stratified into three age groups and each stratum equally and randomly divided into two groups for sclerotherapy [A] or surgery [B]. 1% Sodium tetradecyle sulphate [STD] was used as sclerosant after aspiration of hydrocele. Surgical procedures used were Jaboulay's, Lord's and subtotal excision. Follow up done for three months. Age range was from 15 to 75 years. Hydrocele was right, left and bilateral in 56%, 42% and 2% patients. Postoperative complications included pain [24% and 20%], hematoma [8% and 12%], infection [8% and 12%], recurrence [40% and 12%] and complications related to anesthesia [0% and 36%] in group A and B respectively. Results of sclerotherapy and surgery for hydrocele are comparable with advantage of economy and convenience for sclerotherapy. However, larger study is recommended with comparison between different sclerosants to find the best one with high success rate and minimum complications

Sclerotherapy of idiopathic hydroceles and epididymal cysts: a historical comparison trial of 5% phenol versus tetracycline

Operating time for idiopathic hydroceles and epididymal cysts is scarce as these conditions compete with an increasing caseload of more consequential surgical disease. Therapy is often relegated to repeated aspiration. Sclerotherapy appears to be effective in a majority of published trials, but comparative effectiveness, efficacy and safety of most agents, including phenol versus tetracycline, has not been established A deliberate strategy of re-treatment until cure is not universally practised, with surgery still being offered after single-treatment failures. Two trials, the first consisting of 53 scrotal cysts treated with 5% phenol-in-water and the second, 42 cysts treated with tetracycline, are compared for effectiveness, efficacy and safety of sclerotherapy per se and of re-treatment. Intention-to-treat analysis yields similar cure rates (no re-accumulation three months after last injection) for phenol and tetracycline (83% and 81% respectively, p = 0.8). Per-protocol analysis also yields similar cure rates (100% and 97% respectively, p = 0.26) and mean number of injections to cure (1.34 and 1.12 respectively, p = 0.069), with range 1-4 and 1-3 respectively. Severe pain following tetracycline injection required administration of pre-injection cord block. Other complications occurred equally (25% and 25.7% respectively, p = 0.94) and were trivial except for one case of chronic haematocele treated by orchiectomy in the tetracycline group. Phenol (5%) and tetracycline are equally efficacious sclerosants for idiopathic scrotal cysts, achieving almost 100% cure with re-treatment and matching the efficacy of surgery. Concern about post-treatment fertility applies equally to surgery and demands informed consent for both modalities.

El tiempo de operación para los hidroceles y los quistes epididimales es escaso, ya que estas condiciones triviales compiten con una creciente carga de casos de enfermedades quirúrgicas de mayores consecuencias. La terapia es a menudo relegada a una aspiración repetida. La escleroterapiaparece ser efectiva en la mayoría de los ensayos publicados, pero no se han establecido la seguridad, eficacia y efectividad comparativa de la mayor parte de los agentes, incluyendo el fenol, frente a la tetraciclina. No se practica universalmente una estrategia deliberada de re-tratamiento hasta la cura, ofreciéndose todavía la cirugía, luego de fracasos con tratamientos individuales. Dos ensayos, el primero consistente en 53 quistes escrotales tratados con fenol acuoso al 5%, y el segundo, en 42 quistes tratados con tetraciclina, se comparan en cuanto a efectividad, eficacia y seguridad para laescleroterapia per se y para el re-tratamiento. El análisis de intención de tratamiento produce tasas de curación similares (no hay re-acumulación 3 meses después de la última inyección) para el fenol y la tetraciclina (83% y 81% respectivamente, p = 0.8). El análisis por protocolo también produce tasas de curación similares (100% y 97% respectivamente, p = 0.26) y el número medio de inyecciones paracurar (1.34 y 1.12 respectivamente, p = 0.069), con rangos de 1–4 y 1–3 respectivamente. El dolor severo tras la inyección de tetraciclina requirió hacer un bloqueo espinal de pre-inyec-ción. Asimismo ocurrieron otras complicaciones (25% y 25.7% respectivamente, p = 0.94) y fueron triviales, con excepción de un caso de hematoceles crónicos tratado mediante orquiectomía en el grupo de tetraciclina. El fenol (5%) y la tetraciclina poseen igual eficacia como esclerosantes de los quistes escrotales idiopáticos, ya que logran una curación de casi 100% con el re-tratamiento, e igualan la eficacia de la cirugía...

Hidrocele: tratamiento con polidocanol / Treatment of hydrocele with polydocanol

El tratamiento del hidrocele ha evolucionado en un intento de ofrecer un procedimiento terapéutico mejor tolerado y eficaz que permita atender estos pacientes en forma ambulatoria. El drenaje y la aplicación de sustancias esclerosantes son, en la actualidad, formas de tratamiento frecuentes con buenos porcentajes de resultados satisfactorios, sin embargo, las reacciones locales continúan siendo un inconveniente. En este estudio se analizan 38 hidroceles tratados con polidocanol, agente esclerosante con débil efecto anestésico local. Los resultados muestran porcentajes de curación similares a los obtenidos con otros agentes esclerosantes, con número y magnitud menores de reacciones locales, lo que hace de esta sustancia un producto útil en el tratamiento del hidrocele

Escleroterapia para el hidrocele mediante fenol al 3 por ciento / Sclerotherapy for hydrocele with 3 percent phenol

Se realizó escleroterapia con fenol al 3 por ciento para tratar 15 hidroceles en 14 pacientes adultos, con edad promedio de 47 años. Se practicaron transiluminación y ultrasonido escrotal de hidrocele antes de la escleroterapia con fenol. Se analizaron eficacia del tratamiento, número de sesiones y complicaciones, y se efectuó comparación con un grupo testigo y cuyos enfermos se trataron quirúrgicamente; la eficacia fue de 95 por ciento. En dos casos (13.3 por ciento) el tratamiento consistió en una sesión de escleroterapia; en nueve casos (60 por ciento) en dos sesiones, y otros cuatro casos (26.6 por ciento) en tres sesiones de escleroterapia. esta se realizó en el consultorio. El seguimiento fue de dos meses. No se observaron complicaciones, y se requirieron analgésicos en tres casos (21 por ciento) para el dolor subsecuente al tratamiento. El grupo testigo fue de 10 pacientes, con una eficacia de 100 por ciento; hubo 40 por ciento de complicaciones, con dos casos con edema, uno de hemorragia y uno de hematoma escrotal. El promedio de hospitalización fue de 2.3 días. Se concluyó que la escleroterapia con fenol al 3 por ciento es muy eficaz para los hidroceles, tiene bajo costo económico y evita el tratamiento quirúrgico tradicional

Treatment of hydroceles by aspirations and tetracycline instillations.

In conclusion, tetracycline hydrochloride is an effective and safe sclerosant for the treatment of hydrocele with entailing minimal side effects and low recurrence rate. However, it should not be recommended for the treatment of spermatocele in younger men who still wish to have children, because of the danger of drug epididymitis and resulting infertility. Hydrocele treatment can be performed in younger men who still wish to have children.

Hidrocelectomía por incisión arciforme sobre anillo inguinal superficial / Hydrocelectomy by arc-shaped incision over the superficial inginal ring

Se practicó hidrocelectomía en treinta pacientes con o sin intervención previa en el sitio del hidroceles. Se realizó una incisión arciforme de concavidad cefálica de ñ 4 cm de longitud sobre el anillo inguinal superficial hasta el tejido celular subcutáneo. Los resultados fueron excelentes ya que no se presentó ninguna complicación. Se analiza el procedimiento

Tratamiento del hidrocele mediante aspiración e inyección de tetraciclina / Treatment of hydrocele by aspiration and injection of tetracycline

Se presentan 12 casos de pacientes portadores de hidrocele, tratados mediante punción aspiración e instilación de tetraciclina intravaginal. Se muestran nuestros resultados, demostrándose que es una alternativa útil, inocua, con un bajo porcentaje de recidiva. Se insiste en la necesidad de esterilizar las tabletas de tetraciclina