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Routine pathology evaluation of hydrocele and spermatocele specimens is associated with significant costs and no
Viral S Shah1, Kenneth G Nepple1, Daniel K Lee1
1University of Iowa Department of Urology, Iowa City, Iowa.
Insights
Routine scrotal surgeries like hydrocelectomy and spermatocelectomy rarely yield malignant findings. Pathology analysis of these specimens is often unnecessary, costing nearly $50,000 and offering little clinical benefit.
Area of Science:
- Urology
- Surgical Pathology
- Health Economics
Background:
- Hydrocelectomy and spermatocelectomy are common scrotal surgeries.
- Surgical specimens from these procedures are frequently sent for pathology analysis.
- The necessity and cost-effectiveness of this routine analysis have not been previously evaluated.
Purpose of the Study:
- To evaluate the outcomes and necessity of surgical pathology analysis for hydroceles and spermatoceles.
- To determine the clinical yield of routine pathology examination for these scrotal conditions.
- To assess the financial implications of pathology analysis in these surgical cases.
Main Methods:
- Retrospective chart review of patients undergoing initial hydrocelectomy or spermatocelectomy from January 2000 to August 2013.
- Analysis of the proportion of surgical specimens submitted for pathology examination.
- Estimation of the direct costs associated with pathology analysis.
Main Results:
- A total of 264 scrotal surgeries were reviewed.
- Pathology analysis was performed on 51% of hydrocelectomy and 90% of spermatocelectomy specimens.
- No malignancies were detected in any of the 159 analyzed specimens, with an estimated cost of $49,449.
Conclusions:
- Surgical pathology analysis of hydrocele and spermatocele specimens provides minimal clinical benefit, as no malignancies were identified.
- Discontinuing routine pathology analysis for these specimens could lead to substantial cost savings for patients and healthcare systems.
- This study suggests a need to reconsider current practices regarding the pathological examination of common scrotal surgical specimens.
Purpose:
Hydrocelectomy and spermatocelectomy are routine scrotal surgeries. A significant number of the surgical specimens are sent for pathology analysis. However, to our knowledge no study has been done to examine outcomes and necessity, which results in significant potentially unnecessary costs to the patient and the health care system. We evaluated outcomes and surgical pathology analysis of hydroceles and spermatoceles.
Materials And Methods:
We performed a retrospective, single institution chart review of all patients who underwent initial surgery for hydrocele or spermatocele between January 2000 and August 2013. We determined the number of cases in which a surgical specimen was sent for pathology examination. The cost for each specimen was estimated at the department of pathology.
Results:
A total of 264 routine scrotal cases were performed during the 14-year period. Surgical specimens were sent for pathology analysis in 102 hydrocelectomy cases (51%) and in 57 spermatocelectomy cases (90%). No pathology specimen showed any indication of malignancy. The estimated direct total cost of pathology analysis was $49,449 in this cohort.
Conclusions:
No malignancy was detected in 159 hydrocele and spermatocele specimens during the 14 study years, suggesting that the pathology analysis is of little clinical benefit. Forgoing surgical pathology analysis of these specimens would result in significant cost savings to the patient and the health care system.
