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Practice Variation in the Management of Adult Hydroceles: A Multinational Survey
Mikko Forss1, Kostiantyn Bolsunovskyi1,2, Yung Lee3,4
1Faculty of Medicine, University of Helsinki, Helsinki, Finland.
Background:
Although hydrocele is one of the most common urologic pathologies, it is seldom studied, and the major urologic associations have no guidelines for the management of adult hydroceles.
Objective:
To characterize international practice variation in the treatment of adult hydroceles.
Design Setting And Participants:
An international survey was conducted addressing the management of hydroceles among urologists in Belgium, Denmark, Finland, Iceland, Japan, and the Netherlands from September to December 2020. We invited a random sample of 170 urologists from each country (except Iceland).
Outcome Measurements And Statistical Analysis:
Urologists' treatment options, factors relevant for decision-making, expected patient satisfaction, and outcomes after aspiration versus surgery were assessed.
Results And Limitations:
Of the 864 urologists contacted, 437 (51%) participated. Of the respondents, 202 (53%) performed both hydrocelectomies and aspiration, 147 (39%) performed hydrocelectomies only, and 30 (8%) performed aspiration only. In Belgium (83%), the Netherlands (75%), and Denmark (55%), urologists primarily performed hydrocelectomies only, whereas in Finland (84%), Japan (61%), and Iceland (91%), urologists performed both hydrocelectomies and aspiration. Urologists favored hydrocelectomy for large hydroceles (78.8% vs 37.5% for small), younger patients (66.0% for patients <50 yr vs 41.2% for ≥70 yr), patients with few or no comorbidities (62.3% vs 23.1% with multiple comorbidities), and patients without antithrombotic agents (53.5% vs 36.5% with antithrombotic agents). Most urologists considered patient satisfaction to be highest after hydrocelectomy (53.8% vs 9.9% after aspiration) despite believing that hydrocelectomy is more likely to cause complications (hematoma 77.8% vs 8.8% after aspiration). Estimates varied between countries.
Conclusions:
We found a large variation in the treatment of adult hydroceles within and between countries. Optimization of hydrocele management globally will require future studies.
Patient Summary:
Our international survey shows that treatment of adult hydrocele varies considerably within and between countries.
