Percutaneous aspiration for hydroceles after varicocelectomy

OBJECTIVES:To assess the role and efficacy of aspiration alone in the treatment of hydroceles occurring after varicocelectomy. Hydroceles represent one of the most common complications related to varicocelectomy at any age.METHODS:From September 1990 to 2008 at our department, a total of 453 varicocelectomies were performed. Inclusion and exclusion criteria were created. The patients with postoperative hydrocele formation were followed up every 3 months. Aspiration was suggested and then performed after 2 consecutive follow-up visits showing an enlarged hydrocele. In compliance with the protocol implemented at our institution, the clinicians performed >or=3 aspirations before suggesting surgical treatment.RESULTS:A total of 256 patients were considered for the present study. All patients underwent laparoscopic varicocelectomy, and 31 (11%) developed postoperative hydrocele. Of the 31 patients, 9 (29%) underwent surgical hydrocelectomy after 3 aspirations, 7 (22.5%) had spontaneous resolution of the hydrocele, and 15 (48.5%) were treated with aspiration only. The success rate of aspiration seemed to be related only to the aspirated fluid volume, with <50 mL/aspiration guaranteeing spontaneous resolution in 60% of patients (P <.05).CONCLUSIONS:The results of our study have shown that the management of postoperative hydrocele formation should be conservative for almost 18-24 months, with a minimum of 3 aspirations, if necessary. If confirmed by additional studies, the volume of fluid aspirated from hydroceles could be used as an early indicator of the need for surgery.