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Aspiration and sclerotherapy versus hydrocelectomy for treating hydroceles: a systematic review and meta-analyses

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Abstract

Background

In this meta-analysis, we aimed to compare the hydrocelectomy versus aspiration and sclerotherapy for treating primary hydrocele.

Methods

We included randomized controlled trials (RCTs) and quasi‐RCTs that compared aspiration and sclerotherapy with any type of sclerosants versus hydrocelectomy for primary hydrocele. Studies were identified via a systematic search of the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and ClinicalTrials.gov. Citation tracking of related articles was performed. Data extraction and quality assessment were performed independently by two authors. The primary and secondary outcome measures were compared and analyzed using the Review Manager 5.3.5 software.

Results

Five small RCTs were included in the present study. These 5 RCTs included 335 patients with 342 hydroceles, randomized to aspiration and sclerotherapy (185 patients; 189 hydroceles) and surgery (150 patients; 153 hydroceles). There was no significant difference in clinical cure between sclerotherapy and hydrocelectomy (RR 0.45, 95% CI 0.18 to 1.10). Meta-analysis revealed a significant increase in recurrence in the sclerotherapy group compared with the surgical group (RR 9.43, 95% CI 1.82 to 48.77). There were no significant differences between the two groups in assessing fever, infection, and hematoma.

Conclusion

Aspiration and sclerotherapy is an efficient technique with a higher recurrent rate; therefore, we recommend aspiration and sclerotherapy for patients at high risk for surgery or avoiding surgery. In addition, included RCTs had low methodological quality, low sample size, and invalidated instruments for outcome assessment. Therefore, there is a great need for further methodologically rigorous RCTs with the registered protocol.

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References

  1. Tsai L, Milburn PA, Cecil CL, Lowry PS, Hermans MR (2019) Comparison of recurrence and postoperative complications between 3 different techniques for surgical repair of idiopathic hydrocele. Urology 125:239–242. https://doi.org/10.1016/j.urology.2018.12.004

    Article  PubMed  Google Scholar 

  2. Korkes F, Teles SB, Nascimento MP, de Almeida SS, Codeço AM (2021) Comparison of outcomes and costs of surgery versus sclerotherapy to treat hydrocele. Einstein (São Paulo). https://doi.org/10.31744/einstein_journal/2021GS5920

    Article  PubMed  PubMed Central  Google Scholar 

  3. Brockman S, Roadman D, Bajic P, Levine LA (2022) Aspiration and sclerotherapy: a minimally invasive treatment for hydroceles and spermatoceles. Urology 164:273–277. https://doi.org/10.1016/j.urology.2021.12.009

    Article  PubMed  Google Scholar 

  4. Huzaifa M, Moreno MA (2023) Hydrocele. In: StatPearls [Internet]. StatPearls Publishing, Treasure Island, FL. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559125/

  5. Kaya E, Sikka SC, Kadowitz PJ, Gur S (2017) Aging and sexual health: getting to the problem. Aging Male 20:65–80. https://doi.org/10.1080/13685538.2017.1295435

    Article  PubMed  Google Scholar 

  6. Low LS, Nair SM, Davies AJW, Akapita T, Holmes MA (2020) Aspiration and sclerotherapy of hydroceles and spermatoceles/epididymal cysts with 100% alcohol. ANZ J Surg 90:57–61. https://doi.org/10.1111/ans.15467

    Article  PubMed  Google Scholar 

  7. Ziegelmann M, Dodge N, Alom M, Wymer K, Kohler T, Trost L (2020) Office-based, minimal-incision modified fenestration technique for symptomatic hydroceles under local anesthesia. Urology 135:159–164. https://doi.org/10.1016/j.urology.2019.08.055

    Article  PubMed  Google Scholar 

  8. Önol ŞY, İlbey YÖ, Önol FF, Özbek E, Arslan B, Akbaş A (2009) A novel pull-through technique for the surgical management of idiopathic hydrocele. J Urol 181:1201–1205. https://doi.org/10.1016/j.juro.2008.10.166

    Article  PubMed  Google Scholar 

  9. Lin L, Hong H-S, Gao Y-L, Yang J-R, Li T, Zhu Q-G, Ye L-F, Wei Y-B (2019) Individualized minimally invasive treatment for adult testicular hydrocele: A pilot study. World J Clin Cases 7:727–733. https://doi.org/10.12998/wjcc.v7.i6.727

    Article  PubMed  PubMed Central  Google Scholar 

  10. Taylor WStJ, Cobley J, Mahmalji W, (2019) Is aspiration and sclerotherapy treatment for hydroceles in the aging male an evidence-based treatment? Aging Male 22:163–168. https://doi.org/10.1080/13685538.2018.1425987

    Article  PubMed  Google Scholar 

  11. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (2019) Cochrane Handbook for Systematic Reviews of Interventions. Wiley

    Book  Google Scholar 

  12. Higgins JPT (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560. https://doi.org/10.1136/bmj.327.7414.557

    Article  PubMed  PubMed Central  Google Scholar 

  13. Agrawal MS, Yadav H, Upadhyay A, Jaiman R, Singhal J, Singh AK (2009) Sclerotherapy for hydrocele revisited: a prospective randomised study. Indian J Surg 71:23–28. https://doi.org/10.1007/s12262-009-0006-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Jayakarthik Y, Patil MB (2015) Comparative study of efficacy of injection sclerotherapy versus surgery as primary modality therapy in primary vaginal hydrocoele : a randomised control study. J Evol Med Dent Sci 04:1405–1413. https://doi.org/10.14260/jemds/2015/198

    Article  Google Scholar 

  15. Khaniya S, Agrawal CS, Koirala R, Regmi R, Adhikary S (2009) Comparison of aspiration-sclerotherapy with hydrocelectomy in the management of hydrocele: a prospective randomized study. Int J Surg 7:392–395. https://doi.org/10.1016/j.ijsu.2009.07.002

    Article  PubMed  Google Scholar 

  16. Latif U, Bashir MA, Rashid A, Rehman Q, Shah TA (2008) Hydrocele: surgery vs. sclerotherapy. Prof Med J 15:125–128. https://doi.org/10.29309/TPMJ/2008.15.01.2709

    Article  Google Scholar 

  17. Osman M (1994) Aspiration and tetracycline sclerotherapy of hydrocele: can it replace surgical treatment? Med J Cairo Univ 62(3):199–204

    Google Scholar 

  18. Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, Norris S, Falck-Ytter Y, Glasziou P, deBeer H (2011) GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 64:383–394. https://doi.org/10.1016/j.jclinepi.2010.04.026

    Article  PubMed  Google Scholar 

  19. Daehlin L, Tonder B, L, Kapstad (1997) Comparison of polidocanol and tetracycline in the sclerotherapy of testicular hydrocele and epididymal cyst. BJU Int 80:468–471. https://doi.org/10.1046/j.1464-410X.1997.00358.x

    Article  CAS  Google Scholar 

  20. Shakiba B, Heidari K, Jamali A, Afshar K (2014) Aspiration and sclerotherapy versus hydrocoelectomy for treating hydrocoeles. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD009735.pub2

    Article  PubMed  Google Scholar 

  21. Schulz KF (2010) CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med 152:726. https://doi.org/10.7326/0003-4819-152-11-201006010-00232

    Article  PubMed  Google Scholar 

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Acknowledgements

We wish to thank Arsia Jamali for his invaluable assistance in the preparation of this review. This study was supported by the Firoozgar Clinical Research Development Center, Iran University of Medical Sciences, Tehran, Iran.

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Authors and Affiliations

  1. Department of Urology, Firoozgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

    Behnam Shakiba

  2. Firoozgar Clinical Research Development Center, Iran, University of Medical Sciences, Tehran, Iran

    Behnam Shakiba

  3. Clinical Trial Center (CTC), Tehran University of Medical Sciences (TUMS), Tehran, Iran

    Kazem Heidari

  4. Department of Urology, University of British Columbia, British Columbia’s Children’s Hospital, Vancouver, Canada

    Kourosh Afshar

  5. Alborz University of Medical Sciences (ABZUMS), Taleghani Boulevard, Taleghani Square, Karaj, Iran

    Ali Faegh

  6. Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran

    Hanieh Salehi-Pourmehr

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  1. Behnam Shakiba
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  2. Kazem Heidari
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Correspondence to Ali Faegh.

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Behnam Shakiba, Kazem Heidari, Kourosh Afshar, Ali Faegh, and Hanieh Salehi-Pourmehr have no conflicts of interest or financial ties to disclose.

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Shakiba, B., Heidari, K., Afshar, K. et al. Aspiration and sclerotherapy versus hydrocelectomy for treating hydroceles: a systematic review and meta-analyses. Surg Endosc 37, 5045–5051 (2023). https://doi.org/10.1007/s00464-023-10143-5

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  • DOI: https://doi.org/10.1007/s00464-023-10143-5

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