Aspiration and Sclerotherapy: A Minimally Invasive Treatment for Hydroceles and Spermatoceles.

OBJECTIVE: To describe our contemporary experience with aspiration and sclerotherapy (AS) as a non-surgical alternative for patients with symptomatic hydrocele and spermatocele who prefer non-surgical treatment. MATERIALS AND METHODS: Patients were identified by billing diagnosis code for hydrocele or spermatocele from 2015 to 2019. Patients underwent AS with doxycycline (200-400 mg). Physical examination, ultrasound and aspirate microscopy were used to differentiate hydrocele from spermatocele. Baseline and follow-up data were recorded. RESULTS: In total, 65 patients underwent AS, 54/65 (83%) for hydrocele and 11/65 (17%) for spermatocele with mean aspirate volumes 307 mL (SD 238 mL) and 138 mL (SD 112 mL), respectively. Follow-up data was available for 38/54 (70%) hydroceles and 8/11 (73%) spermatoceles with median follow-up 28 (IQR 23-41) and 22 (IQR 18.5-30.5) months respectively. Relief of patient reported bother associated with scrotal size occurred in 29/38 (77%) hydroceles and 8/9 (89%) spermatoceles. 2/54 (4%) hydrocele patients developed hematoma managed with in-office aspiration. Immediate post-procedural pain occurred in 2/56 (4%) hydroceles and 2/10 (20%) spermatocele. Post-procedural pain requiring more than 5 tablets of hydrocodone/acetaminophen 5mg/325mg occurred in 2/57 (3%) hydroceles and 2/10 (20%) spermatoceles. Surgical repair was ultimately pursued in 3/38 (8%) and 1/9 (11%) patients with persistent hydrocele and spermatocele respectively. CONCLUSION: AS is a safe and effective treatment alternative for hydrocele and spermatocele for patients wishing to avoid surgery.

Comparison of outcomes and costs of surgery versus sclerotherapy to treat hydrocele.

OBJECTIVE: To evaluate the outcomes and costs associated with surgery versus sclerotherapy as treatment of hydroceles. METHODS: A total of 53 men consecutively treated for hydrocele at our organization, between December 2015 and June 2019, were retrospectively analyzed (39 with Jaboulay technique and 14 with sclerotherapy). All charts were reviewed, assessing clinical data, ultrasound findings, surgical data, and post-procedure outcomes. The hospital finance department calculated the cost of outpatient evaluation, complementary tests, supplies, drugs, and professionals' costs throughout all procedures. RESULTS: The median age for both groups was similar (58 and 65 years old). Comorbidities were less frequent in the Surgery Group (20; 51%) than in the Sclerotherapy Group (14; 100%, p<0.05). The median length of hospital stay was 34.5±16.3 hours for the Surgery Group and 4 hours for the Sclerotherapy Group. The mean follow-up period was similar for both groups (85.4±114.8 days after surgery, and 60.9±80.1 days after sclerotherapy, p=0.467). No significant complications occurred in any patient. Success rates were 94.8% after surgery and 92.8% after sclerotherapy. The mean cost per patient was US$2,558.69 in the Surgery Group (Hydrocelectomy Group) and US$463.58 in the Sclerotherapy Group (p<0.0001). Costs directly related to in-hospital treatment procedures were significantly higher for surgery versus sclerotherapy (US$2,219.82±US$1,629.06 versus US$130.64±US$249.60; p<0.0001). CONCLUSION: Sclerotherapy is an excellent treatment option for idiopathic hydrocele as compared to traditional Jaboulay. It has a high success rate, low complication rates, fast discharge and patients return quicker to activities of daily living.

Comparison of outcomes and costs of surgery versus sclerotherapy to treat hydrocele / Comparação entre resultados e custos de cirurgia e de escleroterapia para tratamento de hidrocele

ABSTRACT Objective: To evaluate the outcomes and costs associated with surgery versus sclerotherapy as treatment of hydroceles. Methods: A total of 53 men consecutively treated for hydrocele at our organization, between December 2015 and June 2019, were retrospectively analyzed (39 with Jaboulay technique and 14 with sclerotherapy). All charts were reviewed, assessing clinical data, ultrasound findings, surgical data, and post-procedure outcomes. The hospital finance department calculated the cost of outpatient evaluation, complementary tests, supplies, drugs, and professionals' costs throughout all procedures. Results: The median age for both groups was similar (58 and 65 years old). Comorbidities were less frequent in the Surgery Group (20; 51%) than in the Sclerotherapy Group (14; 100%, p<0.05). The median length of hospital stay was 34.5±16.3 hours for the Surgery Group and 4 hours for the Sclerotherapy Group. The mean follow-up period was similar for both groups (85.4±114.8 days after surgery, and 60.9±80.1 days after sclerotherapy, p=0.467). No significant complications occurred in any patient. Success rates were 94.8% after surgery and 92.8% after sclerotherapy. The mean cost per patient was US$2,558.69 in the Surgery Group (Hydrocelectomy Group) and US$463.58 in the Sclerotherapy Group (p<0.0001). Costs directly related to in-hospital treatment procedures were significantly higher for surgery versus sclerotherapy (US$2,219.82±US$1,629.06 versus US$130.64±US$249.60; p<0.0001). Conclusion: Sclerotherapy is an excellent treatment option for idiopathic hydrocele as compared to traditional Jaboulay. It has a high success rate, low complication rates, fast discharge and patients return quicker to activities of daily living.

RESUMO Objetivo: Avaliar resultados e custos associados à cirurgia e à escleroterapia como tratamentos das hidroceles. Métodos: Foram tratados consecutivamente para hidrocele em nossa instituição 53 homens, entre dezembro de 2015 e junho de 2019, os quais foram analisados retrospectivamente (39 pela técnica de Jaboulay e 14 por escleroterapia). Todos os prontuários foram revisados, avaliando dados clínicos, achados de ultrassom, dados cirúrgicos e desfechos pós-procedimento. O departamento financeiro do hospital calculou o custo da avaliação ambulatorial, dos exames complementares, dos insumos, dos medicamentos e dos profissionais em todos os procedimentos. Resultados: A idade mediana foi semelhante nos dois grupos (58 e 65 anos). Comorbidades foram menos frequentes no Grupo Cirurgia (20; 51%) do que no Grupo Escleroterapia (14; 100%; p<0,05). O tempo mediano de internação hospitalar foi 34,5±16,3 horas para o Grupo Cirurgia e 4 horas para Grupo Escleroterapia. O período médio de seguimento foi semelhante nos dois grupos (85,4±114,8 dias após a cirurgia e 60,9±80,1 dias após escleroterapia; p=0,467). Nenhuma complicação significativa ocorreu nos pacientes. As taxas de sucesso foram de 94,8% após a cirurgia e 92,8% após a escleroterapia. O custo médio por paciente foi de US$2,558.69 para Grupo Cirurgia e US$463.58 para Grupo Escleroterapia (p<0,0001). Os custos relacionados aos procedimentos de tratamento hospitalar foram significativamente maiores para cirurgia em relação à escleroterapia (US$2,219.82±US$1,629.06 versus US$130.64±US$249.60; p<0,0001). Conclusão: A escleroterapia é uma excelente opção de tratamento para hidrocele idiopática em comparação com a tradicional Jaboulay. Apresenta alta taxa de sucesso, baixas taxas de complicações e alta rápida, além de os pacientes retornarem mais rapidamente às atividades diárias.

Hydrocele in Pediatric Population.

Hydrocele is a collection of fluid within the tunica vaginalis. Based upon the etiology and the pathophysiology, it is divided into, the primary and secondary. The primary hydrocele includes the neonatal or the congenital, the communicating and the non-communicating or the closed or the adult type. The secondary hydrocele can develop in the substrate of a pre-existing disease. After systematic and thorough systematic and thorough research of the relevant literature, we aim at describing all the aspects of this entity, with specific emphasis on the issues that remain unanswered from the scientific community.

The outcomes of conservative management and the natural history of asymptomatic hydroceles in children.

PURPOSE: To elucidate the natural history of asymptomatic hydroceles (AHs) in children with conservative management and to discuss management strategies for AHs in children. METHODS: We retrospectively reviewed 113 children with AHs who were followed without immediate surgery. Patients were divided into four groups according to age at presentation; group 1: ≤ 1 month, group 2: 1-12 months, group 3: 12-24 months, and group 4: > 24 months. Ages at spontaneous resolution or surgery were reviewed. To assess the effect of AH on the testis, testicular size before and after conservative management was compared in 11 cases. RESULTS: In groups 1, 2, 3, and 4, spontaneous resolution occurred in 94.3%, 75.0%, 65.0%, and 33.3%, and the average time to resolution from presentation was 5, 5, 17, and 9 months, respectively. 41 patients underwent surgery at a mean age of 4.2 years. The testicular size did not differ significantly between before and after conservative management (14.4 vs. 14.5 mm, p = 0.483). CONCLUSION: About one-third of children over 2 years of age achieve spontaneous resolution. Hydroceles with conservative management may not affect the testicular size. Thus, initial conservative management before surgery is recommend for AHs in children, even over 2 years of age.

Aspiration and sclerotherapy of hydroceles and spermatoceles/epididymal cysts with 100% alcohol.

OBJECTIVE: To evaluate the efficacy of aspiration and sclerotherapy with 100% alcohol for the primary treatment of benign scrotal cysts. METHODS: From March 2014 to March 2018, 114 patients were identified who underwent their first aspiration and sclerotherapy procedure (80 hydroceles and 34 spermatoceles/epididymal cysts). The procedure was carried out in the outpatient clinic with local anaesthesia. A 16-gauge IV catheter is used to puncture the sac under aseptic conditions. The volume of alcohol instilled was 10% of the aspirated volume (maximum of 50 mL). Patients were then observed in the waiting room and completed a questionnaire. Urology clinic follow up was scheduled at 6 weeks. RESULTS: At follow up, 54 patients (67.5%) with hydroceles and 25 patients (73.5%) with spermatoceles/epididymal cysts had resolution after a single procedure. A second procedure was offered if fluid collection persisted, of which 71% of patients with hydroceles and 100% of patients with spermatoceles/epididymal cysts had a successful outcome. At a median of 31 months post-initial procedure, the overall success rate, after at most two procedures, was 80% for hydroceles and 85% for spermatoceles/epididymal cysts. The complication rate was low (6%). Almost all patients were happy to undergo the procedure again, if needed. Persistence following aspiration and sclerotherapy were more likely to occur in younger patients (45.4 versus 61.2 years, P = 0.001). Persistence was not related to the volume of fluid aspirated. CONCLUSION: Aspiration and sclerotherapy with alcohol is a reliable, safe and effective technique for treatment of benign scrotal cysts.

Is aspiration and sclerotherapy treatment for hydroceles in the aging male an evidence-based treatment?

Symptomatic hydroceles are commonly treated with surgical repair. They are associated with sexual dysfunction in the aging male. Patients who are not fit for surgery often undergo aspiration and sclerotherapy of the hydrocele. There is a range of sclerosing agents used in the literature. I performed a literature search to assess whether one sclerosant was better than the others. STDS is the sclerosing agent with the best cure rate after a single injection and low side effect rates. The cure rates of sodium tetradecyl sulphate (STDS) after a single aspiration and injection were 76%. After multiple treatments 94% achieved a cure. Patient satisfaction rates at mean 40 months were 95%. Complication rates were generally low and much lower than surgical repair. Aspiration and sclerotherapy have a role in treating symptomatic hydroceles. This literature review shows that this is over and above its current use in the UK, where it is used for patients unfit for general anaesthetic. If the patients are carefully selected for this procedure, they can have a good outcome and avoid the higher complication rate and longer recovery rates of surgical repair. Patients should be counselled about aspiration and sclerotherapy as part of the informed consent process.

Modulation of the inflammatory response after sclerotherapy for hydrocoele/spermatocoele.

OBJECTIVE: To investigate the modulation of the inflammatory response after sclerotherapy for hydrocoele/spermatocoele. PATIENTS AND METHODS: All patients with hydrocoele or spermatocoele presenting at the Department of Urology, University Hospital, Linköping, Sweden, from 2006 to 2012, were included in this prospective observational study of sclerotherapy for hydrocoele/spermatocoele using polidocanol as a sclerosing agent and adjuvant antibiotic and anti-inflammatory medication (AAAM) for modulation of the inflammatory response. Patients were clinically evaluated within 24-48 h after a complication or adverse event possibly related to sclerotherapy. Evaluation of cure was scheduled after 3 months and re-treatment, if necessary was carried out in the same manner as the first treatment. Groups of patients were compared using the chi-squared test and logistic regression analysis. RESULTS: From a total of 191 patients, AAAM was given to 126, of whom 5% had subclinical epididymitis/swelling (SES) compared to 26% of the patients without AAAM (P < 0.001). No other complication was observed. The rate of cure for the whole group of patients was 93% after one or two treatments and significantly higher in the group with AAAM than in the group without AAAM (96% vs 88%, P = 0.03). CONCLUSIONS: Modulation of the inflammatory response after sclerotherapy resulted in a lower incidence of SES and an increased cure rate.

Varicocele treatment in patients up to 35 years old: a multicentric retrospective study comparing 3 different techniques / Tratamiento del varicocele en pacientes hasta 35 años: estudio retrospectivo multicéntrico comparando 3 técnicas diferentes

OBJECTIVE: To report and compare the clinical outcomes after varicocele treatment managed by open surgery, laparoscopic approach and embolization, with an emphasis in terms of recurrence, complication rate and length of surgery. METHODS: 2 different Portuguese Centers collected pre and postoperative data of patients submitted to varicocele treatment. Over a period of 8 years, 251 cases were evaluated retrospectively and 161 were included and further divided in procedure-related groups. Patients older than 35 years-old were excluded. Laparoscopic Palomo (without artery-sparing technique), artery-sparing Open Palomo surgery and retrograde percutaneous embolization were performed. As outcome measures recurrence/persistence, postoperative hydrocele and other complications were analyzed. Patients were followed a mean of 11.84 months. RESULTS: In the 72 cases in the laparoscopy group, varicocele persisted in 7% and hydrocele developed in 18%. In the 41 patients who underwent retrograde percutaneous embolization recurrent varicoceles were identified in 17% and 10% presented postoperative hydroceles. Of the 48 patients who underwent suprainguinal retroperitoneal open surgery with artery preservation, varicocele recurred in 17%, while hydroceles developed in 6%. The overall success rate, defined as absence of recurrence or persistence of the varicocele during follow-up, was 87.6%. Comparison of reactive hydrocele and recurrence rates with the variables of age, degree of varicocele and length of follow-up showed that both parameters were statistically dependent on the duration of postoperative surveillance (p < 0.05). CONCLUSIONS: Comparison of all 3 groups did not revealed significant differences in varicocele recurrence and hydrocele formation (p > 0.05). Pairwise group comparison showed that open surgery with artery preservation and retrograde embolization might carry a higher risk of recurrence/persistence compared to laparoscopic mass ligation of the spermatic vessels. On the other hand, the laparoscopic approach with en bloc ligation of the spermatic vessels may be associated with a higher risk of secondary hydrocele. According to our data varicocele embolization appears to be slightly less successful than laparoscopy, with similar overall complication rate. Most varicocele recurrences and postoperative hydrocele formation are seen in patients with more than 12 months of follow-up so appropriate length of postoperative surveillance is deemed necessary in these patients

OBJETIVO: Presentar y comparar los resultados clínicos después del tratamiento del varicocele mediante cirugía abierta, laparoscópica o embolización, poniendo énfasis en las recurrencias, complicaciones y duración de la cirugía. MÉTODOS: Dos centros portugueses diferentes recogieron los datos pre y postoperatorios de los pacientes remitidos para tratamiento del varicocele. Durante un periodo de 8 años, 251 casos fueron evaluados retrospectivamente y 161 se incluyeron y posteriormente se dividieron en los grupos relacionados con el procedimiento. Los pacientes mayores de 35 años fueron excluidos. Se realizaron la técnica de Palomo laparoscópica (sin conservación arterial), la cirugía abierta con conservación arterial y la embolización retrograda percutánea. Como medida de resultados se analizaron recurrencia/ persistencia, hidrocele postoperatorio y otras complicaciones. Los pacientes tenían un seguimiento medio de 11,84 meses. RESULTADOS: En los 72 casos del grupo laparoscópico, en el 7% persistió el varicocele y el 18% desarrollaron hidrocele. De los 41 pacientes sometidos a embolización percutánea retrógrada se identificaron varicoceles recurrentes en el 17% y un 10% presentaron hidrocele postoperatorio. De los pacientes sometidos a cirugía abierta retroperitoneal suprainguinal con preservación arterial, el varicocele recidivó en el 17%, mientras que desarrollaron hidrocele el 6%. La tasa global de éxitos, definida como la ausencia de recurrencia o persistencia del varicocele durante el seguimiento, fue del 87,6%. La comparación del hidrocele reactivo y las tasas de recurrencia con las variables edad, grado de varicocele y tiempo de seguimiento mostraron que ambos parámetros eran estadísticamente dependientes de la duración de la vigilancia postoperatoria (p < 0,05). CONCLUSIONES: La comparación de los 3 grupos no reveló diferencias significativas ni en la recurrencia del varicocele ni en la formación de hidrocele (p > 0,05). LA comparación de los grupos por pares mostró que la cirugía abierta con conservación arterial podría tener un mayor riesgo de recurrencia/persistencia en comparación con la ligadura masiva laparoscópica de los vasos espermáticos. Por otro lado, el abordaje laparoscópico con ligadura en bloque de los vasos espermáticos puede asociarse con un riesgo mayor de hidrocele secundario. De acuerdo con nuestros datos la embolización del varicocele parece ser ligeramente menos exitosa que la laparoscopia, con una tasa global de complicaciones similar. La mayoría de las recurrencias del varicocele y la aparición de hidrocele postoperatorio se ven en pacientes con más de 12 meses de seguimiento, así que se considera necesario un tiempo apropiado de seguimiento en estos pacientes

Varicocele treatment in patients up to 35 years old: A multicentric retrospective studycomparing 3 different techniques.

OBJECTIVE: To report and compare the clinical outcomes after varicocele treatment managed by open surgery, laparoscopic approach and embolization, with an emphasis in terms of recurrence, complication rate and length of surgery. METHODS: 2 different Portuguese Centers collected pre and postoperative data of patients submitted to varicocele treatment. Over a period of 8 years, 251 cases were evaluated retrospectively and 161 were included and further divided in procedure-related groups. Patients older than 35 years-old were excluded. Laparoscopic Palomo (without artery-sparing technique), artery-sparing Open Palomo surgery and retrograde percutaneous embolization were performed. As outcome measures recurrence/persistence, postoperative hydrocele and other complications were analyzed. Patients were followed a mean of 11.84 months. RESULTS: In the 72 cases in the laparoscopy group, varicocele persisted in 7% and hydrocele developed in 18% . In the 41 patients who underwent retrograde percutaneous embolization recurrent varicoceles were identified in 17% and 10% presented postoperative hydroceles. Of the 48 patients who underwent suprainguinal retroperitoneal open surgery with artery preservation, varicocele recurred in 17% , while hydroceles developed in 6%. The overall success rate, defined as absence of recurrence or persistence of the varicocele during follow-up, was 87.6%. Comparison of reactive hydrocele and recurrence rates with the variables of age, degree of varicocele and length of follow-up showed that both parameters were statistically dependent on the duration of postoperative surveillance (p<0.05). CONCLUSIONS: Comparison of all 3 groups did not revealed significant differences in varicocele recurrence and hydrocele formation (p>0.05). Pairwise group comparison showed that open surgery with artery preservation and retrograde embolization might carry a higher risk of recurrence/persistence compared to laparoscopic mass ligation of the spermatic vessels. On the other hand, the laparoscopic approach with en bloc ligation of the spermatic vessels may be associated with a higher risk of secondary hydrocele. According to our data varicocele embolization appears to be slightly less successful than laparoscopy, with similar overall complication rate. Most varicocele recurrences and postoperative hydrocele formation are seen in patients with more than 12 months of follow-up so appropriate length of postoperative surveillance is deemed necessary in these patients.

Natural History and Conservative Treatment Outcomes for Hydroceles: A Retrospective Review of One Center's Experience.

OBJECTIVE: To elucidate epidemiological data and hydrocele progression, we reviewed pediatric patients diagnosed with hydroceles in our institution retrospectively. MATERIALS AND METHODS: We reviewed data from 355 pediatric patients with hydroceles. Questionnaires regarding age at diagnosis, time of delivery, presence of hydroceles in the father and brothers, age at recovery, age at surgery, cause of hydrocele (if present), type of hydrocele, associated pathologies, treatments, and posthydrocelectomy complications were completed by reviewing patients' medical records and interviewing their families. RESULTS: Patients with congenital hydroceles were more frequently born prematurely (32.5%) than were patients with noncongenital hydroceles (15.9%; P = .001). Fathers of 10 patients (3.7%) and brothers of 21 patients (7.7%) also had hydroceles. Hydroceles were associated with inguinal hernias on the same side (12.2%), cryptorchidism (7.5%), varicoceles (6.0%), and testis torsion (0.5%). Among patients aged >1 year (n = 185), 27 did not undergo operations and healed spontaneously at an average of 5.30 ± 3.36 months. For children aged >1 year who did not undergo surgery, the rate of spontaneous recovery within 6 months was 77.8% and that within 1 year was 96.3%. CONCLUSION: Until strong evidence of hydrocele-induced testicular damage in children arises, we recommend following up congenital hydroceles until at least 1 year and preferably 2 years of age. We recommend following up noncongenital hydroceles for at least 6 months and preferably 1 year if there is no associated pathology indicating the need for earlier surgery such as an inguinal hernia, cryptorchidism, tense hydrocele, testis torsion, or testis mass.

Giant Scrotal Hydrocele and Bilateral Leg Lymphedema as Clinical Manifestation of Chronic Lymphatic Filariasis.

A 51-year-old male came with the complaint of recurrent swelling in the scrotum and legs. Swelling of the scrotum first appeared 17 years ago in the left scrotum approximately the same size as an apple and underwent surgery. However, 2 years after surgery, the swelling reemerged and gradually increase in size in both scrotums. Left leg swelling began to emerge 5 years ago followed by right leg 3 years after. The patient lives in Sarmi regency Papua province (endemic).

The treatment of abdominoscrotal hydrocele: Is there a role for nonoperative management?

BACKGROUND/PURPOSE: Abdominoscrotal hydrocele (ASH) is an uncommon entity. Until now, the recommended treatment has been surgical. There is only one successful case of nonoperative management reported in literature. We report the largest series of children with ASH, and provide evidence in support of an initial nonoperative approach. METHODS: This study is a retrospective chart review of patients treated from 1994 to 2015 with ASH at a single institution. RESULTS: Thirty patients were identified with ASH, with 29 included in the analysis. Nine patients (30%) had operative management with an 80% complication rate. Twenty out of 29 patients (70%) were initially managed expectantly. Sixteen (80%) had resolution of their abdominal component, twelve (60%) of which went on to have full resolution of ASH. Four patients (20%) in this group required operative management of ASH. CONCLUSIONS: ASH should be included in the differential diagnosis of pediatric scrotal swelling. The "Springing Back Ball Sign" should be used as a screening tool. If it is positive, a dynamic ultrasound should be performed to confirm the diagnosis. We recommend observation as the first step in the management of uncomplicated ASH. It can result in avoidance of operation or at least lower the complication risk significantly if operation is required. LEVEL OF EVIDENCE: 4.

Situational analysis of lymphatic filariasis morbidity in Ahanta West District of Ghana.

OBJECTIVES: Situational analysis of lymphatic filariasis (LF) morbidity and its management in Ahanta West, Ghana, to identify potential barrier to healthcare for LF patients. METHODS: Lymphoedema and hydrocoele patients were identified by community health workers from a subset of villages, and were interviewed and participated in focus group discussions to determine their attitudes and practices towards managing their morbidity, and their perceived barriers to accessing care. Local health professionals were also interviewed to obtain their views on the availability of morbidity management services in the district. RESULTS: Sixty-two patients (34 lymphoedema and 28 hydrocoeles) and 13 local health professionals were included in the study. Lymphoedema patients predominantly self-managed their conditions, which included washing with soap and water (61.8%), and exercising the affected area (52.9%). Almost 65% of patients had sought medical assistance at some stage, but support was generally limited to receiving tablets (91%). Local health professionals reported rarely seeing lymphoedema patients, citing stigma and lack of provisions to assist patients as a reason for this. Almost half of hydrocoele patients (44%) chose not to seek medical assistance despite the negative impact it had on their lives. Whilst surgery itself is free with national health insurance, 63% those who had not sought treatment stated that indirect costs of surgery (travel costs, loss of earnings, etc.) were the most prohibitive factor to seeking treatment. CONCLUSIONS: The information obtained from this study should now be used to guide future morbidity strategies in building a stronger relationship between the local health services and LF patients, to ultimately improve patients' physical, psychological and economic wellbeing.

Paratesticular Rhabdomyosarcoma Presenting With a Giant Abdominoscrotal Hydrocele in a Toddler.

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in infants and children. Paratesticular RMS accounts for approximately 7% of all RMSs. It commonly presents as a painless scrotal mass, which is usually distinct from the testis. We report an unusual case of paratesticular RMS presenting with a giant abdominoscrotal hydrocele in a toddler. To the best of our knowledge, this is the first case of paratesticular RMS presenting with an abdominoscrotal hydrocele.

Assessing numbers and faces: a prerequisite for improving access to lymphatic filariasis morbidity care.

Concerted efforts to eliminate lymphatic filariasis worldwide have registered success; multiple rounds of mass drug administration have led to the interruption of transmission in many previously endemic areas. However, the management of patients with established clinical disease (e.g., lymphoedema, hydrocoele and acute dermatolymphangioadenitis) has not been addressed sufficiently. Two recent studies from Malawi underscore the need for accurate epidemiological and clinical data, and comprehensive morbidity assessments across various domains of daily life. Addressing these issues will guide the implementation of programmes to improve access to treatment and disability prevention for affected individuals in Malawi and beyond.

Aspiration and sclerotherapy versus hydrocoelectomy for treating hydrocoeles.

BACKGROUND: Hydrocoeles are common cystic scrotal abnormalities, described as a fluid-filled collection between the visceral and parietal layers of the tunica vaginalis of the scrotum. There are two approaches for treatment of hydrocoeles: surgical open hydrocoelectomy and aspiration followed by sclerotherapy.  OBJECTIVES: We compared the benefits and harms of aspiration and sclerotherapy versus hydrocoelectomy for the management of hydrocoeles. SEARCH METHODS: We searched the Cochrane Renal Group's Specialised Register to 2 August 2014 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs comparing aspiration and sclerotherapy versus hydrocoelectomy for the management of hydrocoeles. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data and assessed risk of bias in the included studies. Random effects meta-analyses were performed using relative risk (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI). MAIN RESULTS: We found four small studies that met the inclusion criteria. These studies enrolled 275 patients with 282 hydroceles. Participants were randomised to aspiration and sclerotherapy (155 patients with 159 hydroceles) and surgery (120 patients with 123 hydroceles). All studies were assessed as having low or unclear risk of bias for selection bias, detection bias, attrition bias and selective reporting bias. Blinding was not possible for participants and investigators based on the type of interventions. Blinding for statisticians was not reported in any of included studies.There were no significant difference in clinical cure between the two groups (3 studies, 215 participants: RR 0.45, 95% CI 0.18 to 1.10), however there was significant heterogeneity (I² = 95%). On further investigation one study contributed all of the heterogeneity. This could be due to the agent used or perhaps due to the fact that this is a much older study than the other two studies included in this analysis. When this study was removed from the analysis the heterogeneity was 0% and the result was significant (in favour of surgery) (2 studies, 136 participants: RR 0.74; 95% CI 0.64 to 0.85).There was a significant increase in recurrence in those who received sclerotherapy compared with surgery (3 studies, 196 participants: RR 9.37, 95% CI 1.83 to 48.4). One study reported a non-significant decrease in fever in the sclerotherapy group (60 participants: RR 0.25, 95% CI 0.06 to 1.08). There was an increased number of infections in the surgery group however this increase was not statistically significant (4 studies, 275 participants): RR 0.31, 95% CI 0.09 to 1.05; I² = 0%). Three studies reported the frequency of pain in the surgery group was higher than aspiration and sclerotherapy group but because of different measurement tools applied in these studies, we could not pool the results. Radiological cure was not reported in any of the included studies. There was no significant difference in haematoma formation between the two groups (3 studies, 189 participants: RR 0.57, 95% CI 0.17 to 1.90; I² = 0%). Only one study reported patient satisfaction at three and six months; there was no significant difference between the two groups. AUTHORS' CONCLUSIONS: Postoperative complications as well as cost and time to work resumption were less in the aspiration and sclerotherapy group; however the recurrence rate was higher. The cure rate in short-term follow-up was similar between the groups, however there is significant uncertainty in this result due to the high heterogeneity. There is a great need for further methodologically rigorous RCTs that assess the effectiveness of different type of sclerosant agents, sclerosing solution concentration and injection volume for the treatment of hydrocoeles. It is important that the RCTs have sufficiently large sample size and long follow-up period. Studies should evaluate clinical outcomes such as pain, recurrence, satisfaction, complications and cure using validated instruments. The protocols for all studies should be registered in clinical trial registries and the reports of these studies should conform with international guidelines of trial reporting such as CONSORT. Cost-effectiveness studies should also be undertaken.

The long-term efficacy of hydrocele treatment with aspiration and sclerotherapy with polidocanol compared to placebo: a prospective, double-blind, randomized study.

PURPOSE: We evaluate whether aspiration and sclerosing of hydrocele testis is an effective treatment. MATERIALS AND METHODS: Men with symptomatic hydrocele testis were included in this prospective, double-blind, randomized study with polidocanol and placebo. Patients were randomized to active treatment or placebo at the first treatment. Depending on hydrocele testis size (less than 100, 100 to 200 and greater than 200 ml), the patients were treated with 1, 3 or 4 ml polidocanol after aspiration. Patients with recurrence at the 5-week followup received active treatment. RESULTS: A total of 77 patients were included in the study. In group 1 (active treatment) there were 36 patients with a median age of 63 years (range 34 to 92). In group 2, comprised of 41 patients, the median age was 59 years (range 26 to 82). Median followup was 72 months. A significant difference between the groups was observed after the first and second treatments. Recurrence after the first treatment was seen in 16 (44%) patients from group 1 and in 32 (78%) from group 2 (p <0.05). Recurrence after re-treatment with the active drug in both groups was seen in 4 (25%) patients in group 1 and in 14 (44%) in the former placebo group (p <0.05). The overall success rate of treatment in the active group was 89%. There was no difference between the 2 groups in terms of volume of fluid aspirated, symptoms or complications. CONCLUSIONS: This long-term efficacy randomized study with placebo showed that polidocanol is effective for the treatment of hydrocele testis with a low recurrence rate.