Sclerotherapy with tetracycline for hydrocele of the tunica vaginalis testis

Classifying Hydroceles of the Pelvis and Groin: An Overview of Etiology, Secondary Complications, Evaluation, and Management

INTRODUCTION

A hydrocele is defined as the pathological buildup of serous fluid in the pelvis and groin due to various etiologies such as diseases or trauma. It has distinct clinical manifestations, particularly discomfort and psychosocial distress. Understanding the anatomy, embryology, and physiology associated with hydrocele formation is crucial to understand its onset and progression.

MATERIALS AND METHODS

A MEDLINE^® search was conducted using keywords for the relevant classification of hydrocele and its etiology, complications, sexual barriers, evaluation, and management.

RESULTS

Appropriately classifying the hydrocele as primary, secondary communicating, secondary noncommunicating, microbe-induced, inflammatory, iatrogenic, trauma-induced, tumor-induced, canal of Nuck, congenital, and giant is important for identifying the underlying etiology. Often this process is overlooked when the classification or etiology is too rare. A focused evaluation is important for this, so that timely management can be provided. We comprehensively review the classifications, etiology, and secondary complications of hydrocele. Pitfalls of current diagnostic techniques are explored along with recommended methods for accurate diagnosis and current treatment options.

CONCLUSION

Due to the range of classifications and etiologies of hydrocele in the pelvis and groin, a deliberate differential diagnosis is essential to avoiding imminent life-threatening complications as well as providing the appropriate treatment.

Traitement des hydrocèles de l'adulte

Surgery is the gold standard of hydrocele treatment; it is indicated in case of functional disorders. The two principal techniques are Lord's plication procedure, and excision. Main complications consist in potential haematoma and injury to epididymis, vas deferens or cord structures. Two other techniques exist, but with limited indications: fenestration which puts in contact the sac with lymph-rich subcutaneous tissues, and sclerotherapy.

Long-term experience with sclerotherapy for treatment of epididymal cyst and hydrocele

BACKGROUND

Symptomatic testicular hydrocele and cyst of the epididymis may be treated with either operation or sclerotherapy.

METHODS

The current report presents the experience of a 9 year prospective study using sodium tetradecyl sulphate (STD) sclerotherapy for the treatment of symptomatic hydrocele and/or epididymal cyst.

RESULTS

A total of 102 lesions were treated during the study period, with an initial success rate of 76% which improved to 94% with multiple treatments. The overall median follow up during the study was 30 months (range 2-100).

CONCLUSIONS

Sclerotherapy offers a cost-effective outpatient method for the treatment of symptomatic scrotal cysts.

Aspiration sclerotherapy for hydroceles in the tropics

OBJECTIVE

To assess the usefulness of aspiration sclerotherapy in the treatment of hydroceles in the tropics.

PATIENTS AND METHODS

This prospective study included 82 patients with 94 primary vaginal hydroceles of which 62 hydroceles were treated by aspiration and tetracycline hydrochloride sclerotherapy as an outpatient procedure (mean age of patients 56.5 years, range 40-82) and 28 were treated surgically and included as controls (mean age 52.4 years, range 40-70). All patients were followed for a year.

RESULTS

In the sclerotherapy group, the overall cure rate after a year was 95%. Few complications were encountered in this group: six patients (10%) experienced pain during the procedure, seven patients (12%) had local infection and three patients (5%) developed haematoma. No recurrence was encountered in the surgical group, seven patients (25%) had infection and two patients (7%) developed haematoma. The mean hospital stay for the surgical group was 3.4 +/- 1.3 days (range 1-7). Four patients with thick-walled hydroceles had persistent swelling after sclerotherapy, the recurrence of which dissatisfied the patients.

CONCLUSIONS

Aspiration sclerotherapy for thin-walled hydroceles proved to be a curative, simple, safe and cost-effective out-patient procedure. It can be an alternative to surgery in developing countries where resources are limited.

Sclerotherapy of Hydroceles

Objective:

To provide an overview of the indications, actions, efficacy, and safety of various sclerosants for medical treatment of hydroceles.

Data Sources:

Pertinent English-language literature dealing with human studies was retrieved from a MEDLINE search (1966–1994); search terms were sclerosant and hydrocele.

Study Selection:

All English-language clinical trials of sclerotherapy in males with hydroceles were selected. Studies included open, noncomparative study designs because of limitations of published literature. Case reports also were included if they addressed use or safety of sclerosants. Both authors reviewed all cited literature.

Data Extraction:

Data were extracted and analyzed if the information was relevant and consistent. Independent extraction was performed by both authors.

Data Synthesis:

Tetracycline, ethanolamine oleate, sodium tetradecyl sulfate, phenol, antazoline, polidocanol, and bismuth phosphate all have been used as sclerosants for hydroceles. All appear to have comparable efficacy; however, they differ in adverse effects. Severe pain upon injection into the scrotum has been reported with bismuth phosphate; pain is least common with phenol, antazoline, and polidocanol. Allergic reactions have occurred with phenol and tetracycline. Sodium tetradecyl sulfate may impair fertility.

Conclusions:

The most experience over the longest period of time is with tetracycline; however, the parenteral formulation was removed from the commercial market in 1992. Alternative agents with comparable efficacy that are available in the US include ethanolamine oleate, sodium tetradecyl sulfate, and phenol.

The tetracyclines in dermatology

Tetracycline is one of the most widely used antibiotics. It may share some properties with conventional immunosuppressive drugs and act as an anti-inflammatory agent in the treatment of inflammatory disease. This article reviews cutaneous diseases that have been treated with tetracyclines and their antiinflammatory and immunosuppressive properties.