Microsurgical Hydrocelectomy: Rationale and Technique

Abstract

IntroductionHydrocelectomy may be complicated by hematoma, infection, testicular atrophy, epididymal injury and recurrence. Microsurgical hydrocelectomy allows for better visualization of epididymal tubules and testicular vasculature. We investigated the clinical outcomes of microsurgical hydrocelectomy. MethodsWe retrospectively reviewed the charts of all men who underwent microsurgical hydrocelectomy from 1999 to 2013. All operations were performed through a scrotal incision. The spermatic vessels, vas deferens and epididymis were identified under an operating microscope at 6× to 25× magnification. The hydrocele sac was excised under the microscope. Assessment of operative outcomes included postoperative physical examination, need for subsequent fertility treatment and recurrence. Pathology reports were reviewed and descriptive analysis was performed. ResultsMean ± SD patient age was 44.4 ± 17.4 years. Mean hydrocele volume was 275.5 ± 260 ml. The etiology was prior inguinal hernia repair in 21% of patients, nonmicrosurgical varicocelectomy in 16%, recurrent hydroceles in 14%, epididymitis or orchitis in 7%, trauma or scrotal surgery in 7% and an idiopathic cause in 35%. Surgery was performed on 70 units (12 bilateral) in a total of 58 men. There was a 12% postoperative complication rate and all complications were Clavien grade I. No recurrence developed during a mean followup of 68.8 months. At hydrocelectomy concomitant surgical procedures were done in 60% of cases, of which 50% were spermatocelectomy. In 69 hydrocele sac pathology specimens no epididymal tubules were identified. In an older man in whom fertility was not an issue part of the epididymis was intentionally transected with the sac. ConclusionsMicrosurgical hydrocelectomy minimizes the risk of injury to the epididymis, vas deferens or testicular blood supply as well as the risk of infection or hematoma.