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Aspiration and Sclerotherapy: A Minimally Invasive Treatment for Hydroceles and Spermatoceles
Scott Brockman1, Daniel Roadman1, Petar Bajic2
1Division of Urology, Rush University Medical Center, Chicago, IL.
Insights
Aspiration and sclerotherapy (AS) offers a safe, effective non-surgical option for symptomatic hydrocele and spermatocele. Most patients experienced relief from scrotal enlargement, avoiding the need for surgery.
Area of Science:
- Urology
- Minimally Invasive Procedures
Background:
- Symptomatic hydrocele and spermatocele often require surgical intervention.
- Patients may prefer non-surgical treatment options to avoid surgical risks and recovery time.
Purpose of the Study:
- To evaluate the contemporary experience and outcomes of aspiration and sclerotherapy (AS) for symptomatic hydrocele and spermatocele.
- To assess AS as a viable non-surgical alternative for patients who wish to avoid surgical management.
Main Methods:
- A retrospective review of patients undergoing AS for hydrocele or spermatocele between 2015 and 2019.
- AS involved doxycycline injection (200-400 mg) after aspiration.
- Diagnosis differentiation via physical exam, ultrasound, and aspirate microscopy; outcomes assessed via patient-reported bother and need for subsequent surgery.
Main Results:
- 65 patients (54 hydrocele, 11 spermatocele) underwent AS.
- Patient-reported relief of scrotal size bother was achieved in 77% of hydrocele and 89% of spermatocele cases.
- Low complication rates: 4% hematoma (hydrocele), 3-4% significant pain (hydrocele), 20% pain (spermatocele); 8% hydrocele and 11% spermatocele ultimately required surgery.
Conclusions:
- Aspiration and sclerotherapy (AS) is a safe and effective non-surgical treatment for symptomatic hydrocele and spermatocele.
- AS provides significant relief from scrotal enlargement and is a suitable alternative for patients avoiding surgery.
- The procedure demonstrates a favorable outcome profile with minimal complications and a low rate of subsequent surgical intervention.
Objective:
To describe our contemporary experience with aspiration and sclerotherapy (AS) as a non-surgical alternative for patients with symptomatic hydrocele and spermatocele who prefer non-surgical treatment.
Materials And Methods:
Patients were identified by billing diagnosis code for hydrocele or spermatocele from 2015 to 2019. Patients underwent AS with doxycycline (200-400 mg). Physical examination, ultrasound and aspirate microscopy were used to differentiate hydrocele from spermatocele. Baseline and follow-up data were recorded.
Results:
In total, 65 patients underwent AS, 54/65 (83%) for hydrocele and 11/65 (17%) for spermatocele with mean aspirate volumes 307 mL (SD 238 mL) and 138 mL (SD 112 mL), respectively. Follow-up data was available for 38/54 (70%) hydroceles and 8/11 (73%) spermatoceles with median follow-up 28 (IQR 23-41) and 22 (IQR 18.5-30.5) months respectively. Relief of patient reported bother associated with scrotal size occurred in 29/38 (77%) hydroceles and 8/9 (89%) spermatoceles. 2/54 (4%) hydrocele patients developed hematoma managed with in-office aspiration. Immediate post-procedural pain occurred in 2/56 (4%) hydroceles and 2/10 (20%) spermatocele. Post-procedural pain requiring more than 5 tablets of hydrocodone/acetaminophen 5mg/325mg occurred in 2/57 (3%) hydroceles and 2/10 (20%) spermatoceles. Surgical repair was ultimately pursued in 3/38 (8%) and 1/9 (11%) patients with persistent hydrocele and spermatocele respectively.
Conclusion:
AS is a safe and effective treatment alternative for hydrocele and spermatocele for patients wishing to avoid surgery.
