Aspiration and sclerotherapy of hydroceles and spermatoceles/epididymal cysts with 100% alcohol

ANZ J Surg. 2020 Jan;90(1-2):57-61. doi: 10.1111/ans.15467. Epub 2019 Oct 18.

Abstract

Objective: To evaluate the efficacy of aspiration and sclerotherapy with 100% alcohol for the primary treatment of benign scrotal cysts.

Methods: From March 2014 to March 2018, 114 patients were identified who underwent their first aspiration and sclerotherapy procedure (80 hydroceles and 34 spermatoceles/epididymal cysts). The procedure was carried out in the outpatient clinic with local anaesthesia. A 16-gauge IV catheter is used to puncture the sac under aseptic conditions. The volume of alcohol instilled was 10% of the aspirated volume (maximum of 50 mL). Patients were then observed in the waiting room and completed a questionnaire. Urology clinic follow up was scheduled at 6 weeks.

Results: At follow up, 54 patients (67.5%) with hydroceles and 25 patients (73.5%) with spermatoceles/epididymal cysts had resolution after a single procedure. A second procedure was offered if fluid collection persisted, of which 71% of patients with hydroceles and 100% of patients with spermatoceles/epididymal cysts had a successful outcome. At a median of 31 months post-initial procedure, the overall success rate, after at most two procedures, was 80% for hydroceles and 85% for spermatoceles/epididymal cysts. The complication rate was low (6%). Almost all patients were happy to undergo the procedure again, if needed. Persistence following aspiration and sclerotherapy were more likely to occur in younger patients (45.4 versus 61.2 years, P = 0.001). Persistence was not related to the volume of fluid aspirated.

Conclusion: Aspiration and sclerotherapy with alcohol is a reliable, safe and effective technique for treatment of benign scrotal cysts.

Keywords: alcohol; aspiration; hydrocele; sclerotherapy; spermatocele.

MeSH terms

  • Adult
  • Cysts / therapy*
  • Epididymis
  • Ethanol
  • Humans
  • Male
  • Middle Aged
  • Patient Satisfaction
  • Retreatment / statistics & numerical data
  • Retrospective Studies
  • Sclerosing Solutions / therapeutic use
  • Sclerotherapy / methods*
  • Suction
  • Testicular Diseases / therapy
  • Testicular Hydrocele / therapy*

Substances

  • Sclerosing Solutions
  • Ethanol