Aspiration and Sclerotherapy for the Management of Hydrocele in an Ambulatory and Regional Setting

Aim: To assess the efficacy and safety of aspiration and sclerotherapy for the management of hydroceles in an ambulatory regional setting. Methods: A retrospective analysis was performed on all men who underwent aspiration and sclerotherapy for the management of symptomatic hydroceles at a single regional Australian centre from 1 January 2006 to 31 December 2023. All procedures were carried out in an ambulant setting under local anaesthetic and sodium tetradecyl sulphate (STD) as the sclerosing agent. Results: 291 men were included in the study with a median follow-up of 99 days. Resolution of hydrocele both clinically and symptomatically post initial aspiration and sclerotherapy was 58.8% (171/291). The average time to recurrence for men who failed initial management was 167 days (IQR 28–112 days). Following initial aspiration and sclerotherapy, 67.7% (63/93) of men with recurrence chose to have a repeat aspiration and sclerotherapy of these men, and 68.3% (43/63) had resolution of their hydroceles. Hence, after two aspiration and sclerotherapy interventions, 73.5% (214/291) of men had clinical and symptomatic resolution of their hydroceles. The median age of participants was 62.3 years (IQR 52.1–70.8). The median initial aspirated volume was 150 mL (IQR 100–250 mL), and the injected volume was 10 mL (IQR 8–10 mL). Notably, the median aspirated volume decreased for men with a recurrence to 100 mL (IQR 63.8–143.8 mL), and an injected volume of 0 ml (IQR 0–4.8 mL). The overall complication rate was 3.4% (10/291), of which all but one was managed conservatively. Conclusion: Aspiration and sclerotherapy with STD represent a minimally invasive, safe and effective treatment for hydroceles that can be utilized in the regional and ambulatory settings under local anaesthetic, potentially reducing wait times for interventions and improving patient flow for public hospital waitlists.