Is aspiration and sclerotherapy treatment for hydroceles in the aging male an evidence-based treatment?

[Hydrocele]

The hydrocele is overall a rare condition in urology. A differentiation between primary and secondary hydrocele is essential for further treatment. A primary hydrocele with a patent vaginal process tends to spontaneously regress in the first 2 years of life in newborns. If treatment is necessary, open as well as laparoscopic methods are available with good results. The treatment of scrotal pathologies, especially secondary hydrocele, often poses a challenge in the clinical practice. Despite the benign nature, supposedly simple surgical techniques and good chances of healing, postoperative complications are frequent. In comparison to open surgery, sclerotherapy provides a good alternative for the treatment of secondary hydrocele.

Sclerotherapy in the Treatment of Hydroceles: A Comprehensive Review of the Efficacy, Types of Sclerosants, and Comparative Outcomes Against Hydrocelectomy

While hydrocelectomy is the gold-standard for treating hydroceles, it poses an increased risk to patients and a greater burden to the healthcare system. Sclerotherapy is an alternative treatment for hydroceles that involves injecting a sclerosant into the hydrocele under ultrasound guidance. This literature review aimed to assess the types of sclerosants used and how sclerotherapy compares to hydrocelectomy. A literature search was conducted of MEDLINE and EMBASE using the terms "sclerotherapy" and "hydrocelectomy," which yielded 1058 studies, of which 29 met the inclusion criteria. Only studies published after 2000 were included to ensure the most recent information was reviewed. The results showed hydrocele sclerotherapy is done using a variety of sclerosants. The most used agents are polidocanol, phenol, and STS. Of these, phenol had the highest clinical success rate of 96.5%. There was evidence for the use of atypical agents, such as tetracycline antibiotics, which yielded cure rates up to 93%, and alcohol, which was found to be especially useful for treating multiseptated hydroceles. The results comparing sclerotherapy to hydrocelectomy indicated hydrocelectomy to be a more effective method in completely curing hydroceles. However, this came at the cost of more complications. Additionally, sclerotherapy was found to be more advantageous for secondary outcomes, such as healthcare costs and burden to patients. In conclusion, this review shows that while hydrocelectomy is more effective, sclerotherapy is a valuable alternative for treating hydroceles. Due to the lack of standardization among studies, a definitive conclusion cannot be made regarding which sclerosant is best to use.

Aspiration and sclerotherapy versus hydrocelectomy for treating hydroceles: a systematic review and meta-analyses

BACKGROUND

In this meta-analysis, we aimed to compare the hydrocelectomy versus aspiration and sclerotherapy for treating primary hydrocele.

METHODS

We included randomized controlled trials (RCTs) and quasi-RCTs that compared aspiration and sclerotherapy with any type of sclerosants versus hydrocelectomy for primary hydrocele. Studies were identified via a systematic search of the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and ClinicalTrials.gov. Citation tracking of related articles was performed. Data extraction and quality assessment were performed independently by two authors. The primary and secondary outcome measures were compared and analyzed using the Review Manager 5.3.5 software.

RESULTS

Five small RCTs were included in the present study. These 5 RCTs included 335 patients with 342 hydroceles, randomized to aspiration and sclerotherapy (185 patients; 189 hydroceles) and surgery (150 patients; 153 hydroceles). There was no significant difference in clinical cure between sclerotherapy and hydrocelectomy (RR 0.45, 95% CI 0.18 to 1.10). Meta-analysis revealed a significant increase in recurrence in the sclerotherapy group compared with the surgical group (RR 9.43, 95% CI 1.82 to 48.77). There were no significant differences between the two groups in assessing fever, infection, and hematoma.

CONCLUSION

Aspiration and sclerotherapy is an efficient technique with a higher recurrent rate; therefore, we recommend aspiration and sclerotherapy for patients at high risk for surgery or avoiding surgery. In addition, included RCTs had low methodological quality, low sample size, and invalidated instruments for outcome assessment. Therefore, there is a great need for further methodologically rigorous RCTs with the registered protocol.

A challenging abdomino-scrotal hydrocele-successful resolution with the help of interventional radiology guided sclerosis

Abdomino-scrotal hydrocele is a rare condition that presents in male infants. There is no consensus in the literature over treatment. We present the case of a 4-year-old boy with what was thought to be a straight forward congenital hydrocele that persisted despite ligation of a patent processus vaginalis and a Jaboulay procedure. A subsequent Magnetic Resonance Imaging scan identified a large intra-abdominal component connecting to the scrotum. Laparoscopic excision of the intra-abdominal component was performed successfully, but the hydrocele persisted. The hydrocele resolved without complication following two episodes of image intensifier guided sclerotherapy carried out by the interventional radiology team.