Evaluating Safety Outcomes for Benign Scrotal Surgery Performed Under Local Anesthesia

Benign scrotal conditions, including hydroceles, spermatoceles, and epididymal cysts, are frequently managed surgically under general or spinal anesthesia. Although this ensures adequate intraoperative analgesia, these methods increase perioperative risk, cost, and resource utilization. Local anesthesia (LA) offers a potential alternative, but contemporary outcome and complication data specific to benign scrotal surgery are limited.

We conducted a retrospective review of all adult patients undergoing hydrocelectomy, spermatocelectomy, epididymectomy, or testicular biopsy under LA alone at an ambulatory surgical center from October 2022 to February 2025. An equal mixture of 1% lidocaine and 0.25% bupivacaine was administered through a spermatic cord block and along the median raphe. Patient demographics, intraoperative events, postoperative complications, emergency department visits, primary care follow-up, and hospital admissions were analyzed with descriptive statistics.

A total of 303 procedures were performed: 43.6% hydrocelectomies, 33.3% spermatocelectomies, 10.2% epididymectomies, and 12.2% testicular biopsies. Mean patient age was 52.5 years, and mean BMI was 30.0 kg/m². All surgeries were successfully completed under LA without conversion or procedural termination. No intraoperative complications were reported. At 4- to 6-week follow-up, no patients required family physician visits for procedure-related issues; 1.0% (n = 3) presented to the emergency department for suspected wound infections, and no hospital admissions occurred.

Benign scrotal procedures can be safely and effectively performed in an ambulatory setting under LA alone, with low complication rates and high procedural success. This approach offers significant potential to improve surgical efficiency, reduce health care costs, and enhance access to timely urologic care.