Sclerosant treatment for hydroceles and epididymal cysts

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

Symptomatic hydroceles are commonly treated with surgical repair. They are associated with sexual dysfunction in the aging male. Patients who are not fit for surgery often undergo aspiration and sclerotherapy of the hydrocele. There is a range of sclerosing agents used in the literature. I performed a literature search to assess whether one sclerosant was better than the others. STDS is the sclerosing agent with the best cure rate after a single injection and low side effect rates. The cure rates of sodium tetradecyl sulphate (STDS) after a single aspiration and injection were 76%. After multiple treatments 94% achieved a cure. Patient satisfaction rates at mean 40 months were 95%. Complication rates were generally low and much lower than surgical repair. Aspiration and sclerotherapy have a role in treating symptomatic hydroceles. This literature review shows that this is over and above its current use in the UK, where it is used for patients unfit for general anaesthetic. If the patients are carefully selected for this procedure, they can have a good outcome and avoid the higher complication rate and longer recovery rates of surgical repair. Patients should be counselled about aspiration and sclerotherapy as part of the informed consent process.

Sclerotherapy for large hydrocoeles in Nigeria

Sclerotherapy with tetracycline hydrochloride was used to treat 99 patients with large hydrocoeles (range 300-1500 ml). The mean age of these patients was 52 years. In 55.5% of the patients one treatment was adequate. Two treatments were required in 22%; three in 10%; four in 3%; and five in 7% of the patients. In two patients sclerotherapy failed. Complications were minimal. Only 15% of the patients complained of severe pain. The overall success rate was 98%. Tetracycline sclerotherapy for large hydrocoeles is effective, safe and economical and is preferred for older patients who are at risk from anaesthetic complications.

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.

Tetracycline sclerotherapy for testicular hydroceles in renal transplant recipients

OBJECTIVES

To study the efficacy of tetracycline sclerotherapy in renal transplant recipients with symptomatic hydroceles.

METHODS

A total of 21 patients with symptomatic hydroceles following renal transplantation underwent aspiration of hydrocele and injection of tetracycline hydrochloride. Sclerosant solution was prepared by dissolving 1 g tetracycline hydrochloride powder in 10 mL 1% lidocaine. The amount of sclerosant used depended on the volume of the sac: 5 mL for a sac containing up to 100 mL and 2.5 mL of sclerosant was added for each increase of 100 mL in sac volume.

RESULTS

Twelve patients (57%) required only one treatment and 9 patients (43%) had up to 3 injections. The larger the hydrocele, the more treatments were required. The resolution of hydrocele was complete in 12 patients (57%) and partial in 7 (33%) with 2 (10%) failures. Pain at injection was observed in one third of the patients. No major complications (fever, hematoma, infections, abscess, or scrotal necrosis) occurred in any patient. No changes in the structure or size of the testicles were found by ultrasound during an average follow-up period of 35 months.

CONCLUSIONS

Tetracycline sclerotherapy is a safe, effective, and economical form of out-patient therapy that can be recommended as primary treatment for hydroceles in patients who have undergone renal transplantation.

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.

Efficacy of endoscopic hydrocele ablation

We describe a new endoscopic technique that was used for the treatment of symptomatic scrotal hydroceles in 10 men. Through a small skin incision, the parietal surface of the tunica vaginalis was ablated endoscopically using either electrocautery or the KTP:YAG laser. This approach permitted visual inspection of the scrotal contents with minimal manipulation and was performed using monitored local anesthesia with bilateral spermatic cord blocks. With a mean follow-up interval of 6.1 months, no hydrocele recurrences, wound infections, or hematomas have been detected. The mean operative time was comparable (53 minutes) to that in a historical control group consisting of 15 men who had undergone open hydrocelectomy at our institution (46 minutes). Postoperative scrotal discomfort was minimal, with 6 of the 10 patients requiring no analgesics. Patients were able to resume their preoperative lifestyles an average of 2 days after surgery. In contrast, 11 of the 15 men in the control group was still complaining of scrotal pain, requiring oral analgesics, at their 2-week follow-up visit. Thus, endoscopic hydrocele ablation appears to be an effective and well-tolerated alternative to treat hydroceles with minimal postoperative discomfort.

Endoscopic hydrocele ablation

A new technique for the treatment of hydroceles by percutaneous drainage and endoscopic ablation under direct vision is described. The possible benefits and drawbacks of this treatment modality for symptomatic hydroceles are discussed.

Ethanolamine oleate sclerotherapy for hydroceles and spermatoceles: a survey of 158 patients with ultrasound followup

Sclerotherapy with 5% ethanolamine oleate was used to treat 102 hydroceles in 100 patients and 63 spermatoceles in 58 patients. Scrotal ultrasound examination was performed before the sclerotherapy and at each followup visit. Of the hydroceles 98% were cured completely and 68% were cured after only 1 sclerosant instillation, while 60% of the spermatoceles resolved completely and 33% partially, with 7% failures. No hydroceles recurred during an average followup of 43 months, whereas spermatocele recurred in 4 patients more than 1 year after successful treatment, with a mean followup of 46 months. Approximately half of the patients experienced pain after treatment, 3 had infection and 2 had hematoma. No changes in the structure or size of the testicles were found by ultrasound during followup. Ethanolamine oleate sclerotherapy is a safe, effective and economical form of outpatient therapy that can be recommended as primary treatment for hydroceles in adults and as an alternative to surgery for spermatoceles with 1 to 3 cysts in elderly men in whom fertility is not important.

Aspiration and tetracycline sclerotherapy of hydrocele

Seventeen patients with hydrocele of the testis were treated by aspiration of fluid and substitution with tetracycline supplemented with 1% lidocaine. In 15 patients (88%) symptoms disappeared by sclerotherapy. After sclerotherapy scrotal ultrasonography was useful to diagnose either relapse or thickened tunica vaginalis. No side effect was noticed.

Comparative trial of sclerotherapy for hydroceles

We present a prospective single-blind trial of sclerotherapy for hydroceles with tetradecyl sulphate and rolitetracycline as sclerosants. Twenty-seven hydroceles were treated with tetradecyl sulphate and 28 with rolitetracycline. The median follow-up was 13 months. There were no statistically significant differences between the 2 drugs in respect of cure rate and complications. The overall cure rate for both drugs was 96%. Complications were rare and common to both drugs. Tetradecyl sulphate and rolitetracycline were found to be equally effective as sclerosants.

Phenol sclerotherapy for hydrocele: a study in 55 patients

Sclerotherapy with 2.5% phenol solution was used to treat 63 hydroceles in 55 patients with a mean age of 69 years. In 51.6% of the patients (32 hydroceles) 1 treatment was sufficient, while 2 treatments were necessary in 25.8% (16 hydroceles), 3 in 13% (8 hydroceles) and 4 in 8% (5 hydroceles). One patient required 7 injections. Treatment was unsuccessful in 1 patient in whom a local allergic reaction developed. Only 1 patient complained of pain, and other complications were rare and mild. On the basis of this experience we concluded that sclerotherapy with phenol 2.5% is a painless, highly effective, safe and economical procedure that permits one to avoid an operation, anesthesia and hospitalization. Its use is warranted in adults and particularly in the elderly.

Ethanolamine oleate as a sclerosant for testicular hydroceles and epididymal cysts

Forty patients with testicular hydroceles and 16 patients with epididymal cysts were treated by tapping and injection of ethanolamine oleate; 97.5% of the hydroceles and 31% of the epididymal cysts were completely cured, 50% of the latter partly cured and 19% failed. About half of the patients experienced pain after treatment. Two patients developed infection. Ultrasonography showed no change in the testicular tissue during the follow-up period. Sclerotherapy with ethanolamine oleate is a rapid and cost-effective modality which can be recommended as primary treatment for hydroceles and for unilocular epididymal cysts, especially in elderly males.

Aspiration and tetracycline sclerotherapy of hydroceles

Aspiration and sclerotherapy of hydroceles have been considered an effective outpatient procedure. We report on our experience with modification of this procedure in the treatment of 28 hydroceles. A 10 per cent solution of tetracycline hydrochloride was used as the sclerosant. In this series the mean followup was 15 months and there was an over-all 93 per cent success rate. A single treatment was successful in 75 per cent of the hydroceles. Complications included a hematoma in 2 patients and epididymitis in 1. We consider aspiration and sclerotherapy of hydroceles to be a reasonable alternative to an operation.

Testicular hydrocele treated by bismuth phosphate injection

Thirty-eight testicular hydroceles were treated by injection with 0.2-0.4 g of bismuth phosphate. The follow-up was completed in 32 cases, 17 (53%) of which showed complete regression although one patient had to wait 24 months for full regression. Eight patients (25%) showed clinical improvement and one patient (3%) had residual scrotal tenderness after otherwise successful treatment. Six patients (19%) did not improve and were treated surgically. The method may present an alternative to surgery in elderly patients with testicular hydrocele.

Sclerotherapy with tetracycline solution for hydrocele

A study of sclerotherapy for hydrocele using different concentrations (10%, 5%, 2.5%) for tetracycline solution was done on 24 patients, 23 patients were cured. The effectiveness of sclerotherapy was the same for the three groups of patients with use of each different concentration of the solution. Pain was the only adverse effect. Nonspecific cellular foreign body reaction and fibrin strand proliferation were observed in the hydrocele fluid after this procedure. We consider sclerotherapy for hydrocele with tetracycline solution safe and the procedure of choice for patients in whom surgery or anesthesia is contraindicated, for patients who refuse surgery, and for economic reasons.

Sclerosant therapy for hydroceles and epididymal cysts

Hydroceles and epididymal cysts presenting in 30 patients were treated by tapping and injection of the sclerosant solution sodium tetradecylsulphate. Ten patients required only one treatment and 20 patients had up to 3 repeat injections. There have been no recurrences in patients completing the course of treatment and the complication rate was low.