Introduction: This study examined single institution post-operative outcomes of aspiration alone, vs. aspiration with instillation of either ethanol, doxycycline, or Sodium Tetradecyl Sulphate (STDS) based on hydrocele recurrence and complications. There are no previous studies that compare these four techniques, all of which are commonly used for therapeutic intervention. In this study, we evaluated the rate of disease recurrence based on follow up ultrasound and/or patient examination, as well as time to postoperative recurrence and postoperative complications.
Methods: Total of 176 patients, consisting of 68 aspiration-alone patients, 59 patients sclerosed with ethanol, 30 patients sclerosed with doxycycline, and 19 patients sclerosed with STDS from January 2012 to September 2021 in our institution, were included in this study. Following treatment, we compared rates of recurrence, complication, and time to recurrence.
Results: Use of any sclerosis agent had a lower likelihood of hydrocele recurrence, and this was statistically significant (44.4% vs. 70.6%, p<0.01). Examined individually, only ethanol was found to have a significantly lower rate of recurrence than aspiration alone (39.0% vs. 70.6%, p<0.01). Ethanol was not found to have a difference in time to hydrocele recurrence when compared to aspiration alone (5.09 vs. 6.1 days, p = 0.63). STDS was found to have a lower rate of recurrence than aspiration alone, however these results were not significant (47.4% vs. 70.6%, p = 0.06). However, STDS was found to have a longer length of time to hydrocele recurrence than aspiration alone (13.2 vs. 6.1 days, p=0.04). When compared directly, ethanol had a slightly lower rate of recurrence than STDS however this was not significant (39.0% vs. 47.4%, p=0.518). The overall complication rate was 1.7%. There were 3 complications, an infection in the aspiration alone group, a postoperative bleed in the STDS group, and a repeat procedure for severe pain in the STDS group. These were not statistically significant.
Conclusions: Ethanol was the most effect sclerotic agent in our patient cohort. Though similarly effective, STDS is interestingly roughly twice as expensive as ethanol at our institution. Hydrocele recurrence was not significantly improved with STDS however, though it did delay timing to recurrence onset. We conclude that ethanol sclerosis is both more effective, and cost effective, than STDS sclerosis. Future studies with increased patient numbers may help confirm these conclusions.
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