Treatments

Non-surgical Hydrocele Treatment: Sclerotherapy

Posted on by Prof. Dr. Özgür KILIÇKESMEZ

Sclerotherapy is an alternative to surgical methods for hydrocele treatment. This procedure is performed to eliminate excess fluid in the scrotal sac. During treatment, doctors inject a sclerosing agent into the cavity using a needle. As a result, this agent causes the cavity walls to adhere, preventing future fluid accumulation. The success rate of sclerotherapy is quite high, ranging between 85 % and 90 %. The likelihood of recurrence is low. However, this treatment is not recommended for patients with additional health issues such as hernias.

What Is Sclerotherapy?

Sclerotherapy is a medical procedure based on injecting irritant substances into veins. During treatment, the inner walls of varicose veins are deliberately damaged to cause the vein to close. This process triggers inflammation and ultimately leads to vein disappearance. The sclerosing agents used include:

  • Osmotic agents: glycerin and hypertonic saline.
  • Detergents: polidocanol and sodium tetradecyl sulfate.
  • Iodinated agents.

Sclerotherapy is generally preferred for cosmetically concerning or painful varicose veins in the lower extremities. It also provides an effective solution for some hemorrhoid cases. Modern medical literature has included sclerotherapy since the 1850s, gaining popularity in the 1940s with the introduction of sodium tetradecyl sulfate. Today, it is considered the gold standard for treating venous insufficiency.

What Is Hydrocele?

Hydrocele is a condition characterized by abnormal swelling of the scrotal sac. The term originates from Greek, combining the words for water and tumor. The disease involves fluid accumulation between the membranes surrounding the testes. Under normal conditions, only a small amount of lubricating fluid is present between these membranes:

  • Normal fluid volume: 0.5 – 1 ml.
  • In hydrocele: 100 – 200 ml or more.

This excess causes scrotal swelling and sometimes pain. If untreated, it can lead to discomfort and cosmetic issues. Hydroceles often occur without any underlying health problem.

How Is Sclerotherapy Performed for Non‑Surgical Hydrocele Treatment?

Sclerotherapy for hydrocele is a minimally invasive approach. First, the fluid accumulated in the hydrocele sac is carefully drained with a sterile needle. This ensures the sac is completely empty. Then, a sclerosing solution—usually containing doxycycline or sodium tetradecyl sulfate—is injected. The injection process involves:

  • Ensuring the sac is completely empty.
  • Preparing the specified sclerosing solution.
  • Slowly injecting the solution into the sac.

After injection, the solution reacts with the inner lining of the sac, triggering scar formation. This prevents the sac from refilling with fluid. The procedure is typically performed under local anesthesia and can be done on an outpatient basis. Each session lasts 15 – 30 minutes.

How Successful Is Sclerotherapy for Hydrocele?

Sclerotherapy for hydrocele carries fewer complication risks and is more cost‑effective compared to surgery. Using doxycycline, sclerotherapy achieves an impressive single‑session success rate of 84 %, which is higher than that with tetracycline:

  • Doxycycline: 84 % success rate.
  • Tetracycline: 75 % success rate.

Other sclerosing agents show varying success rates:

  • Polidocanol: 51.7 % to 94 % overall success rate.
  • Alcohol: 80 % to 97.62 % overall success rate.

The effectiveness of each agent varies based on treatment protocol and hydrocele characteristics.

What Are the Side Effects and Risks of Sclerotherapy?

Sclerotherapy for non‑surgical hydrocele treatment is generally preferred but may cause some side effects. The most common is bruising at the injection site, which tends to resolve within days to weeks. Mild swelling and redness at the treatment area are also common and usually temporary.

  • Bruising: Occurs after injection and heals quickly.
  • Swelling and Redness: Temporary discomfort at the injection site.
  • Itching and Burning: May last a few days post‑treatment.
  • Hyperpigmentation: Temporary darkening of the skin along the treated vein; may be permanent in rare cases.
  • Small Skin Ulcers: May form at the injection site and are usually minor.

Rare side effects include inflammation at the injection site and small blood clots in treated veins. These are generally manageable with pain relievers but can occasionally lead to more serious issues.

  • Inflammation: Causes swelling and discomfort.
  • Blood Clots: Can form in treated veins and may progress to more serious conditions.
  • Air Emboli: Can enter circulation, causing headache or nausea.
  • Allergic Reactions: Rarely occur against the sclerosing solution.

These side effects are typically temporary and manageable, but patients should be informed before treatment. Overall, sclerotherapy is an effective and safe option.

What Is the Post‑Treatment Process?

The post‑treatment period for non‑surgical hydrocele sclerotherapy includes important steps to support recovery and comfort. After sclerotherapy, patients should follow these recommendations:

Physical Activity:

  • Recommended: Light activities like walking to promote circulation and prevent clots.
  • Avoid: Strenuous exercises like running or heavy lifting.

Avoid Heat and Prolonged Positions:

  • Avoid heat exposure: No hot baths, saunas, hot tubs, or sunbathing for at least two weeks.
  • Avoid prolonged sitting or standing: Take frequent walks to stretch legs and improve circulation.

Hydration and Nutrition:

  • Drink plenty of water to speed recovery.
  • Eat a balanced, nutrient‑rich diet; avoid alcohol and caffeine.

Follow‑Up and Monitoring:

  • Attend all scheduled follow‑up visits.
  • Avoid medications like aspirin or ibuprofen without doctor approval.

What Are the Advantages of Sclerotherapy?

Sclerotherapy offers many advantages over surgical methods for hydrocele treatment. This minimally invasive approach induces fibrosis in the sac by injecting a sclerosing agent, reducing fluid buildup. It provides lower complication rates compared to surgery and is more cost‑effective, offering an economical solution for patients. Recovery is faster, allowing patients to return to normal activities sooner. Typically performed on an outpatient basis, sclerotherapy eliminates the need for hospital admission, reducing additional costs and inconvenience. Key advantages include:

  • Minimal invasiveness
  • Low complication rates
  • Cost‑effectiveness
  • Rapid recovery
  • Outpatient treatment capability

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