Practice Variation in the Management of Adult Hydroceles: A Multinational Survey

• Published in: European Urology Open Science
• Main Authors: Forss, Mikko, Bolsunovskyi, Kostiantyn, Lee, Yung, Kilpeläinen, Tuomas P., Aoki, Yoshitaka, Gudjonsson, Sigurdur, Hervé, François, Järvinen, Petrus, Malde, Sachin, Miyazawa, Katsuhito, Sairanen, Jukka, Sander, Lotte, Violette, Philippe D., Witte, Lambertus P.W., Guyatt, Gordon H., Tikkinen, Kari A.O.
• Format: Text
• Language: English
• Published: Elsevier 2023
• Subjects: Reconstructive Urology; Iceland
• Online Access: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10751538/; http://www.ncbi.nlm.nih.gov/pubmed/38152484; https://doi.org/10.1016/j.euros.2023.09.005

BACKGROUND: Although hydrocele is one of the most common urologic pathologies, it is seldom studied, and the major urologic associations have no guidelines for the management of adult hydroceles. OBJECTIVE: To characterize international practice variation in the treatment of adult hydroceles. DESIGN, SETTING, AND PARTICIPANTS: An international survey was conducted addressing the management of hydroceles among urologists in Belgium, Denmark, Finland, Iceland, Japan, and the Netherlands from September to December 2020. We invited a random sample of 170 urologists from each country (except Iceland). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Urologists’ treatment options, factors relevant for decision-making, expected patient satisfaction, and outcomes after aspiration versus surgery were assessed. RESULTS AND LIMITATIONS: Of the 864 urologists contacted, 437 (51%) participated. Of the respondents, 202 (53%) performed both hydrocelectomies and aspiration, 147 (39%) performed hydrocelectomies only, and 30 (8%) performed aspiration only. In Belgium (83%), the Netherlands (75%), and Denmark (55%), urologists primarily performed hydrocelectomies only, whereas in Finland (84%), Japan (61%), and Iceland (91%), urologists performed both hydrocelectomies and aspiration. Urologists favored hydrocelectomy for large hydroceles (78.8% vs 37.5% for small), younger patients (66.0% for patients <50 yr vs 41.2% for ≥70 yr), patients with few or no comorbidities (62.3% vs 23.1% with multiple comorbidities), and patients without antithrombotic agents (53.5% vs 36.5% with antithrombotic agents). Most urologists considered patient satisfaction to be highest after hydrocelectomy (53.8% vs 9.9% after aspiration) despite believing that hydrocelectomy is more likely to cause complications (hematoma 77.8% vs 8.8% after aspiration). Estimates varied between countries. CONCLUSIONS: We found a large variation in the treatment of adult hydroceles within and between countries. Optimization of hydrocele management globally will require ...