V11-11: Hydrocelectomy Using a Minimally-invasive, Office-based Approach
Hydroceles are a common cause of benign scrotal swelling. Historically, various techniques have been employed including aspiration and sclerosis and open surgical excision, plication, or inversion with variable outcomes. More recently, a minimally-invasive eversion technique was described. Here, we sought to show how this technique can be adapted in an office-based setting utilizing local anesthesia and review associated outcomes.
A consecutive database was maintained of men undergoing an office-based, eversion technique for symptomatic hydroceles between June 2015 and October 2017. All patients underwent incisional and cord block local anesthesia, after which the hydrocele sac was sequentially everted through a small incision, excised, and oversewn without delivering the testicle through the wound. Patient demographics and clinical outcomes were assessed via retrospective chart review.
A total of 27 men (median age 70 years; range 34-87) underwent an in-office hydrocelectomy under local anesthesia. Median estimated hydrocele size was 300 cc (range 100-800). Medical comorbidities included coronary artery disease (22%), congestive heart failure (11%), diabetes mellitus (19%), chronic pulmonary disease (11%), and prior venous thrombo-embolic event (11%). 13/27 patients (48%) were on antiplatelet or anticoagulation at the time of the procedure, and 5/27 (19%) were not deemed sufficiently healthy for general anesthesia. At a median follow-up of 14-months (range 1-22), recurrences occurred in 3/27 (11%), with recurrence size estimated at ? 50% of the original hydrocele in all patients. Post-procedural hematomas occurred in 2/27 patients (7%), and only 1/27 (4%) required repeat intervention for drainage of a symptomatic hematoma.
The minimally-invasive, office-based eversion hydrocelectomy represents a viable surgical technique with excellent outcomes. This technique may be especially advantageous in men who are considered poor candidates for general anesthesia due to the presence of comorbidities or require ongoing anticoagulation or antiplatelet therapy.