Ethanolamine oleate as a sclerosant for testicular hydroceles and epididymal cysts

A Complication of Percutaneous Sclerotherapy for Congenital Pulmonary Airway Malformation: Intravascular Injection and Cardiac Necrosis

INTRODUCTION

A congenital pulmonary airway malformation (CPAM) type III may become large enough to cause hydrops fetalis. In such circumstances, the fetus can be treated with open fetal resection, maternal betamethasone administration, or percutaneous sclerotherapy.

CASE REPORT

A 24 week gestation fetus with a CPAM type III was treated by percutaneous sclerotherapy using ethanolamine oleate (EO). The EO inadvertently entered the left atrium and ventricle with subsequent fetal bradycardia and demise. Autopsy revealed myocardial necrosis.

CONCLUSION

Percutaneous sclerotherapy has been previously described in the literature for the treatment of microcystic CPAMs with secondary hydrops. This is the first reported case of an adverse event after fetal sclerotherapy.

Sclerotherapy for Simple Cysts with Use of Ethanolamine Oleate: Preliminary Experience

We evaluated the efficacy of ethanolamine oleate (EO) as a sclerosing agent for a symptomatic hepatic or renal cyst. Seven patients with symptomatic hepatic (n = 3) or renal cysts (n = 4) were treated by sclerotherapy with EO. The cyst size in the greater diameter ranged from 6 to 13 cm. The cyst was punctured under ultrasound guidance, and after all of the cyst's content was aspirated, an iodized contrast agent was injected to check the absence of communication between the cyst and biliary tree, urinary tract, or vessels. Then, the solution of ethanolamine oleate-iopamidol mixture (EOI) of 10% of the volume of the cyst's content was injected via catheter. After 30 min, the injected EOI was aspirated completely before catheter removal. A follow-up computed tomography scan was performed at 1 and 3 months after treatment. The volume of the cyst and its reduction rate was calculated. In addition, symptoms and complications were assessed. The volume of the cyst ranged from 64 to 636 ml (mean: 328 ml) before treatment. Three months after treatment, it ranged from 2 to 50 ml (mean: 15ml) and the reduction rate of the cyst's volume was more than 90% on average. Symptoms caused by the cyst disappeared in all cases and no major complication was encountered. Although two patients had a low-grade fever after sclerotherapy, it was easily controlled. It is suggested that the sclerotherapy with EO might be a safe, effective, well-tolerated treatment for symptomatic hepatic or renal cysts.

Sclerotherapy of Hydroceles

Objective:

To provide an overview of the indications, actions, efficacy, and safety of various sclerosants for medical treatment of hydroceles.

Data Sources:

Pertinent English-language literature dealing with human studies was retrieved from a MEDLINE search (1966–1994); search terms were sclerosant and hydrocele.

Study Selection:

All English-language clinical trials of sclerotherapy in males with hydroceles were selected. Studies included open, noncomparative study designs because of limitations of published literature. Case reports also were included if they addressed use or safety of sclerosants. Both authors reviewed all cited literature.

Data Extraction:

Data were extracted and analyzed if the information was relevant and consistent. Independent extraction was performed by both authors.

Data Synthesis:

Tetracycline, ethanolamine oleate, sodium tetradecyl sulfate, phenol, antazoline, polidocanol, and bismuth phosphate all have been used as sclerosants for hydroceles. All appear to have comparable efficacy; however, they differ in adverse effects. Severe pain upon injection into the scrotum has been reported with bismuth phosphate; pain is least common with phenol, antazoline, and polidocanol. Allergic reactions have occurred with phenol and tetracycline. Sodium tetradecyl sulfate may impair fertility.

Conclusions:

The most experience over the longest period of time is with tetracycline; however, the parenteral formulation was removed from the commercial market in 1992. Alternative agents with comparable efficacy that are available in the US include ethanolamine oleate, sodium tetradecyl sulfate, and phenol.

Sclerotherapy of hydroceles with polidocanol

Fifteen patients with hydroceles of the testis or spermatic cord were treated by aspiration and injection of the sclerosant solution polidocanol. The cure rate of hydroceles after one sclerotherapy session was 73%, and the overall cure rate using the procedure was 87%. No patient experienced pain during or after the procedure, which was conducted without anaesthesia. No complications were observed. It is concluded that sclerotherapy of hydroceles with polidocanol may be a useful alternative to open operation, due to its ease of administration, low frequency of complications, and high rate of effectiveness, and that this agent is preferable to certain other drugs in that it causes no pain during or after the injection.

Results of window operation for primary hydrocele

The window operation for hydrocele repair has been reported to be a safe out-patient procedure, with few complications and relapses. In this pilot study the procedure could be safely done on an out-patient basis and the rate of complications (8%) was comparable to that of other procedures. However, 21/23 evaluated hydroceles relapsed and retreatment with a second window operation led to further relapses within a short time. Eight patients with 11 hydroceles required another procedure. We have therefore abandoned the window operation for hydrocele repair.

Treatment of hydrocele: randomised prospective study of simple aspiration and sclerotherapy with tetracycline

Following reports in the literature on the efficacy of tetracycline sclerotherapy in the treatment of hydroceles, we carried out a randomised prospective study of 45 patients (50 hydroceles), comparing simple evacuation with tetracycline sclerotherapy. The results revealed no statistically significant difference in the percentage of success between the 2 groups, but complications were more common in the patients treated with tetracycline. The good results reported by other authors in non-randomised studies are, therefore, not confirmed.

Treatment of hydrocele testis with aspiration and injection of polidocanol

Hydroceles of the testis were treated by aspiration and injection of the sclerosant solution polidocanol in 20 patients. Three patients had recurrences but otherwise the complication rate was nil. Injection of polidocanol is a promising treatment that should be investigated further for primary therapy of hydrocele of the testis. In contrast to some other agents this drug does not cause pain during or after the injection.

Lord's procedure--the best operation for hydrocele?

A prospective study was carried out to compare Lord's hydrocele operation with traditional surgical procedures. The groups of patients investigated were comparable in terms of age, period of observation, number of previous aspirations and size of hydrocele. The incidence of isolated hydrocele of the spermatic cord, as well as epididymal cysts, was lower in the patients who underwent Lord's procedure (7.2 versus 15.8%), as was the percentage of patients reporting post-operative pain for more than 3 days (4.3 versus 15.8%, p less than 0.05).