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

Abstract

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.

Comparison of sodium tetradecyl sulphate versus conventional hydrocelectomy for adult hydrocele aspiration.

“…4,6 another less painful and comparatively comfortable procedure is to repeatedly aspirate the fluid, but it increases the risk of recurrent infections. 7 The commonly reported intra-operative complications are bleeding, damage to the cord arrangements and epididymis, and rotation of the testis after a defective finding postoperatively. 8,9 in the last decade the exemplary alteration were recorded in minimally invasive surgeries, sclerotherapy gained popularity as a safe, effective, and painless procedure with minimal duration required for hospital stay and recovery, reduced financial burden, and patient satisfaction or convenience is also improved in sclerotherapy.…”