Hydrocelectomy under local anesthesia with systemic analgesic support: real-world feasibility and patient acceptance

Following implementation of a standardized hydrocelectomy protocol under local anesthesia combined with systemic analgesia at a tertiary referral center, we evaluated its feasibility, safety, and patient acceptance.

In this retrospective single-center study, 35 consecutive patients underwent hydrocelectomy between May 2024 and August 2025 via a standardized in situ spermatic cord block. All patients received protocol-based systemic analgesia (1 g metamizole i.v. and 7.5 mg piritramide s.c.). Anticoagulants were paused 48 h preoperatively and resumed postoperatively, while antiplatelet therapy was continued. The primary endpoint was completion without conversion to analgosedation or general anesthesia. Secondary endpoints included procedural pain (VAS), postoperative complications (Clavien-Dindo), and patient satisfaction.

Hydrocelectomy was completed under local anesthesia and systemic analgesic support in 33/35 patients (94%). One patient required conversion to analgosedation, one to general anesthesia. Seventeen patients (48.5%) were ASA III-IV. Median peak procedural pain was moderate (VAS 6, IQR 0-8) and inversely correlated with age (ρ =  - 0.485, p = 0.005). Two patients (5.7%) required surgical revision (Clavien-Dindo IIIb), and four minor complications were managed conservatively. No complications were attributed to the anesthetic technique, and no recurrence occurred within 90 days. Overall, 87.5% of patients were satisfied and would recommend it.

Hydrocelectomy under local anesthesia combined with systemic analgesia is feasible, safe, and well tolerated. Despite transient moderate procedural pain, most patients did not require conversion to procedural sedation or general anesthesia, with high satisfaction. These results support a patient-centered, resource-efficient approach, particularly for older and comorbid patients, including those with ASA III-IV classification, and warrant further prospective evaluation.