140 - Aspiration and Sclerotherapy as an Alternative to Hydrocelectomy in the Management of Hydroceles: A Retrospective Cohort Study

Monday, April 13, 2026

3:09 PM - 3:18 PM ET

Presenting Author(s)

ND

Nadia Dorca, BS

Presenting Author
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada., Canada

Author/Co-author(s)

OM

Oleg Mironov, MD

Co-Author
Department of Radiology, McMaster University, Hamilton, ON, Canada; St Joseph's Healthcare Hamilton, Hamilton, ON, Canada, Canada
EM

Edward Matsumoto, MD

Co-Author
Department of Urology, McMaster University, Hamilton, ON, Canada; St Joseph's Healthcare Hamilton, Hamilton, ON, Canada, Canada
SM

Syed Umair Mahmood, MD

Co-Author
Department of Radiology, McMaster University, Hamilton, ON, Canada; St Joseph's Healthcare Hamilton, Hamilton, ON, Canada, Canada
BS

Bobby Shayegan, MD

Co-Author
Department of Urology, McMaster University, Hamilton, ON, Canada; St Joseph's Healthcare Hamilton, Hamilton, ON, Canada, Canada
LL

Lorraine Liang, MD

Principal Investigator
Department of Urology, McMaster University, Hamilton, ON, Canada; St Joseph's Healthcare Hamilton, Hamilton, ON, Canada, Canada

Purpose: Hydrocele is the accumulation of serous fluid within the tunica vaginalis, resulting in a fluid-filled scrotal sac. While hydrocelectomy is the management gold standard, it presents various risks. Sclerotherapy is a less invasive alternative, however, present literature lacks thorough exploration of sclerotherapy as an alternative to hydrocelectomy. The purpose of this study is to evaluate the efficacy and safety of sclerotherapy for hydroceles at a high-volume institution and to identify factors predicting treatment success/complications.

Materials and Methods: This retrospective single-arm cohort study assessed 118 male patients (mean age 63.2 ± 13.9 years) who underwent sclerotherapy for hydrocele at our institution between January 2020 - January 2025. Inclusion criteria were a hydrocele diagnosis and completion of sclerotherapy at our center; exclusion criteria were a prior hydrocelectomy. We analyzed patient demographics, comorbidities, procedural details, and outcomes (recurrence, complications, satisfaction).

Results: The overall recurrence rate after initial sclerotherapy was 38.9% (46/118). Factors associated with recurrence included bilateral hydroceles (OR 3.14, p=0.027), inguinal hernias (OR 2.70, p=0.048), volume of fluid aspirated (OR 1.002 /cc, p=0.026), and post-procedural complications (OR 2.53, p=0.032). Conscious sedation was associated with a lower risk of recurrence than local anesthesia alone (OR 0.41, p=0.045). Notably, sclerosant type (1%, 2%, or 3% STS) and form (foam vs. liquid) were not significantly associated with recurrence. The overall complication rate was 25.4% (30/118) - solely Clavien-Dindo Grade I events. Current smoking was a strong predictor of complications (OR 15.3, p=0.015). The rate of subsequent conversion to hydrocelectomy was 4.2% (5/118).

Conclusion: Sclerotherapy is an effective non-surgical approach to hydrocele management, with its efficacy and safety strongly influenced by patient factors (bilaterality, comorbidities, smoking) and procedural factors (sedation), rather than sclerosant formulation. These findings may guide patient selection, procedural technique, and counselling to optimize sclerotherapy outcomes and provide valuable nuance to its success as an alternative to hydrocelectomy. Limitations of this study include its retrospective design and single-center origin.