Hydrocelectomy versus conservative follow-up for symptomatic hydroceles in infertile men: A pilot study

To evaluate the advantages and disadvantages of hydrocele repair in infertile men. The outcome measures were changes in testicular size, semen analysis, and natural pregnancy rate postoperatively.

This pilot study was conducted between January 2021 and April 2024. Inclusion criteria were male patients with a 1-year history of infertility associated with symptomatic hydroceles >100 mL and abnormal semen parameters. Thirty-one men underwent hydrocele surgery, while 30 opted for conservative follow-up. Repeat semen analysis and testicular ultrasonography were performed 6 months after surgery.

Primary infertility was reported in 65% of the patients, and two-thirds had unilateral hydroceles. Both groups were comparable in baseline semen parameters, testicular size, and demographic data. The natural pregnancy rate was documented 1 year after surgery. Pregnancy rates were higher in the surgery group than in the conservative group (7 [22.58%] and 5 [16.67%], respectively), although this difference was not statistically significant. No statistically significant differences were observed in semen analysis post-surgery or follow-up. A mild but statistically significant reduction in testicular size was noted after surgery (p<0.001). More than 80% of patients reported satisfaction with the surgery. The overall complication rate was 15%, with only two patients requiring further surgical intervention.

Hydrocelectomy can be offered safely to infertile men. It is associated with high patient satisfaction and minimal side effects. Larger randomized controlled trials are required to confirm its positive effects on natural pregnancy.