Remote Outcomes of Sclerotherapy with Ethanol in Hydrocele Patients
DOI:
https://doi.org/10.61841/0eyen577Keywords:
Hydrocele, Sclerotherapy, Ethanol, SpermatogenesisAbstract
Introduction. Conventional methods of treating hydrocele are rather traumatic and seem unsatisfying to both doctors and patients; therefore, their improvement is needed.
The objective of this study is to evaluate the efficiency and safety of sclerotherapy of hydrocele with 96% ethanol.
Patients: 117 patients aged from 35 to 89, with hydrocele volume over 100 ml, were divided into three groups: 34 patients who received sclerotherapy by the studied method, 25 patients who received conventional sclerotherapy, and 58 patients who received a widely adopted surgery. The improved sclerotherapy included 30–40 min exposure to ethanol, subsequent evacuation of ethanol from the scrotum, and repeated injection of 5–10 ml of ethanol without evacuation.
Results: In Group I, the first sclerotherapy cured 97.1% of patients; in Group II, 72%. During the two months after the therapy, complications were observed in 14.5%, 16%, and 62.2% of patients, respectively. In Group I, 24 patients assessed tolerability as excellent and 10 patients as good. In Group II, only 13 patients assessed tolerability as excellent, while 8 patients marked it as poor. In Group III, 20 patients assessed tolerability as excellent and 16 patients as poor. The spermatogenesis rate was 8.7±0.5 before and 8.6±0.4 after the sclerotherapy (Johnsen scale modified by De Kretser and Holstein). The testicle volume on the hydrocele side was 20.9±1.5 cm³ after sclerotherapy, compared to 25.2±2.2 cm³ prior to it. The linear blood flow velocity in parenchyma arteries was 0.104+0.020 m/s before and 0.122+0.024 m/s after the sclerotherapy. The average resistivity index in parenchyma arteries was 0.81±0.05 m/s before and 0.74±0.06 m/s after the sclerotherapy. These average values were found to be statistically reliable (р<0.05). No reliable change in the spermogram was revealed 6 months after the treatment.
Conclusions. The improved sclerotherapy with 96% ethanol minimized the hydrocele relapse and reduced early postoperative complications. This method showed no adverse effect upon the testicle tissue; on the contrary, it conduced to better blood supply and lymph efflux from the parenchyma, which can be confirmed by the examination results.
Downloads
References
[1] Tiktinskiy O.L., Kalinina S.N., Mikhaylichenko V.V. Andriatrics. Moscow: MIA, 2010 (Rus.).
[2] Dagrosa LM, McMenaman KS, Pais VM. Tension Hydrocele: An Unusual Cause of Acute Scrotal Pain. Pediatr Emerg Care 2015; 31(8):584-5.
[3] Dovgilev N.V. Radio wave surgery of hydrocele. (Author’s abstract of PhD dissertation in Med. Sc.) Tver, 2010 (Rus).
[4] Mihmanli I., Kantarci F., Kulaksizoglu H. Testicular size and vascular resistance before and after hydrocelectomy. AJR Am J Roentgenol. 2004 Nov;183(5):1379-85.
[5] Yamamichi G., Tsutahara K., Okusa T., et al. Traumatic Testicular Rupture Complicated with Hydrocele: A Case Report. Hinyokika Kiyo. 2015 Oct;61(10):411-3.
[6] Grinev A.V., Serdyutskiy V.E., Efremenkov D.S. Curing hydrocele with a plasma scalpel. Androl. i genit.khir 2005; 2: 32-34 (Rus).
[7] Yang XD, Wu Y, Xiang B, Wong K, Pei J, Li FY. Ten years of experience with laparoscopic repair of pediatric hydrocele and the long-term follow-up results. J Pediatr Surg 2015; 50(11):1987-90.
[8] Yin Z., Yang J.R., Wang Z., et al. Application of scrotoscope in the diagnosis and treatment of testicular and epididymal diseases. Beijing Da Xue Xue Bao. 2015 Aug 18;47(4):648-52.
[9] Peng Y., Li C., Lin W., Xu L. Application of a Laparoscopic, Single-port, Double-needle Technique for Pediatric Hydroceles with Multiple Peritoneal Folds: A Trial from a Single-center 5-Year Experience Urology. 2015 Jun;85(6):1466-70.
[10] Sim S.R. Minimal Hydrocelectomy with the aid of a scrotoscope: a ten-year experience. Int Braz J Urol.
2015 Jan-Feb;41(1):184.
[11] Malysheva T.F., Balashov A.T., Malyshev V.A. Sclerotherapy of fluid caverns in the scrotal organs, ultrasound controlled. Androl. i genit. khir. 2005; 2:50–54 (Rus).
[12] Shan C.J., Lucon A.M., Pagani R., Srougi M. Sclerotherapy of hydroceles and spermatoceles with alcohol:
results and effects on the semen analysis, Int. Braz. J. Urol. 2011 May-Jun;37(3):307-12.
[13] Nikitin D.M., Rakevich M.V. Ethiopathogenetic role of the metabolic syndrome in the genesis of male
Infertility: Review of Literature. Reproductive health: Eastern Europe. 2015; 4(40):93-103 (Rus).
[14] Manganiello M., Hughes C.D., Hagander L., et al. Urologic disease in a resource-poor country. World J
Surg. 2013 Feb;37(2):344-8.
[15] Kliesch S. Hydrocele, spermatocele, and vasectomy: management of complications. Urologe A. 2014 May;53(5):671-5.
[16] Saber A. Minimally invasive versus conventional hydrocelectomy: a randomized trial. Randomized Controlled Trial. Int Braz J Urol 2015 Jul-Aug; 41(4):750-6.
[17] Guzenko V.M., Babyuk I.A., Mamchenko E.I. Minimal-invasive cure of patients with hydrocele. International Medical Journal. 2007; 1: 92–94 (Rus).
[18] Rowe N.E., Martin P., Luke P.P. The Western snip, stitch, and tug hydrocelectomy: How I do it. Can Urol Assoc J. 2016 Sep-Oct; 10(9-10):E328-E330.
[19] Lord P.H. A bloodless operation for the radical cure of idiopathic hydrocele, Brit. J. Surg. 1964; 51(12): 914-916.
[20] Cimador M., Castagnetti M., De Grazia E. Management of hydrocele in adolescent patients. Nat Rev Urol. 2010 Jul;7(7):379-85.
[21] Metcalfe M.J., Spouge R.J., Spouge D.J. et al. The use of TPA in combination with alcohol in the treatment of the recurrent complex hydrocele. Can Urol Assoc J. 2014 May;8(5-6):E445-8.
[22] Adaletli I., Kurugoglu S., Kantarci F. et al. Testicular volume before and after hydrocelectomy in children. J Ultrasound Med. 2006 Sep;25(9):1131-6.
Downloads
Published
Issue
Section
License
Copyright (c) 2020 AUTHOR
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format for any purpose, even commercially.
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
- The licensor cannot revoke these freedoms as long as you follow the license terms.
Under the following terms:
- Attribution — You must give appropriate credit , provide a link to the license, and indicate if changes were made . You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
Notices:
You do not have to comply with the license for elements of the material in the public domain or where your use is permitted by an applicable exception or limitation .
No warranties are given. The license may not give you all of the permissions necessary for your intended use. For example, other rights such as publicity, privacy, or moral rights may limit how you use the material.
