[Local anesthesia in the surgical management of hydrocele and cysts of the spermatic cord]. / La anestesia local en el tratamiento quirúrgico del hidrocele y quiste de cordón espermático.

Traditional management of vaginal fluid collections has always been surgery. The benignancy of this disease does not correspond with the morbidity caused by the anaesthetic techniques used. Over the last few years, sclerotherapy has become increasingly attractive as an alternative to hydrocelectomy. Indications are, nonetheless, restricted, presenting a relapse rate which varies according to the substance used and the operating team. The study proposes the use of local anaesthetics for the surgery of vaginal fluid collections so as to minimize the immediate postoperative period and thus the hospital stay. Between May and October 1991, 55 patients, 49 with hydrocele (4 bilateral) and 6 with sperm cord cyst, were treated in our Unit. Patients were monitored in the theatre (EKG, blood pressure and oximeter) to supervise their life constants, and 2% Mepivacaine (10-20 cc) was infiltrated into the sperm cord and the area of scrotal wall to be cut. Surgical techniques range from dissection to scission of the bag until partial eversion, requiring the use of reabsorbable suture and a careful haemostasis to avoid drainage. Anaesthetics tolerance has been highly satisfactory in 52 patients (94%), good in one patient (2%) and unsatisfactory in two cases (4%). Recorded complications include: severe bradycardia and hypotension in one case (2%), persistent right renoureteral pain in one case (2%), scrotal haematoma in 5 cases (9%) and suture dehiscence in another patient (2%). It is concluded that surgical management of vaginal collection with local anaesthetics is feasible, and reduces the immediate postoperative period also avoiding morbidity derived from a more aggressive anaesthetic technique.