Hydrocele aspiration and injection sclerotherapy under local anaesthetic: a viable alternative to open surgical repair

ABSTRACT

Introduction: Hydroceles could cause discomfort, scrotal heaviness, cosmetic problems or adversely impact quality of life. Conventional treatment involves open surgical repair under general anaesthetic. Aspiration and injection sclerotherapy is however an attractive alternative since literature suggests it has comparable outcomes, lower complication rates and can be performed under local anaesthetic (LA) in timely manner. Patients and Methods: Consenting patients were prospectively recruited following necessary approvals. The procedure was carried out under LA and ultrasound guidance at our urology clinic. The hydrocele was drained and sclerosant (3% sodium tetradecyl sulphate) immediately injected into the tunica vaginalis. Post-procedure followup ranged from 3-12months. Results: Thirty-two patients with 35 procedures (2 re-do, 1 bilateral) were studied. Average volume drained was 283ml (18-1000ml). Overall success rate was 77.1% (complete resolution- 21 [60.0%], mild re-accumulation without need for re-intervention- 4 [11.4%], moderate re-accumulation successfully treated with re-do sclerotherapy- 2 [5.7%]). Large/significant recurrence was noted in 8 (22.9%) patients- they all had large (>200ml) hydroceles ab-initio and went on to have straightforward open surgical repair. One procedure was abandoned due to traumatic aspiration and was excluded. Conclusions: Hydrocele aspiration and injection sclerotherapy under LA is safe, easy to set-up and effective, with trend towards better outcomes for smaller hydroceles. This treatment could ease waiting-list pressures occasioned by the COVID-19 pandemic and should be considered as part of informed consent process for all men with hydroceles. Further data is required to define most suitable patients and also to fully assess ease of hydrocele repair after failed sclerotherapy.