The majority of patients can be treated conservatively with watchful waiting only. The urologist, however, performs hydrocelectomy or spermatocelectomy commonly because a certain proportion of men require intervention for pain, infection or symptoms related to the size of the fluid collection.

One group in Edmonton, Alberta performed a retrospective study examining all outpatient hydrocelectomy and spermatocelectomy procedures. At this facility, 13 different urologists performed scrotal surgery. The primary goal of the study was to better characterize the incidence and nature of complications that occur perioperatively. The results were reported by Kiddo D.A., Wollin T.A., et al, in the February, 2004 issue of the Journal of Urology.

A total of 161 patients underwent either hydrocelectomy (97) or spermatocelectomy (50) or both procedures (14) at an outpatient facility. The mean age of the cohort was 53.7 years and mean follow-up was 6 weeks. Preoperative antibiotics were prescribed in 5 of the 161 cases (3.1%). The majority of patients (85%) received a chlorhexadine gluconate scrub. The remainder underwent a Betadine (R) scrub. Quarter-inch penrose drains were used in 47 patients, closed suction drains were used in 2 patients, with no drains in the remainder.

The total complication rate was 19.2% (31 of 161 cases). The overall success rate of the surgery was 90.7%. Those who failed had persistent swelling. No patient required reoperation for swelling or hematoma formation. Post-operative infection occurred in 15 of 161 patients (9.3%). The rate of infection in patients who received a betadine scrub was 18.2% (4 of 22) compared to 8.1% (11 of 136) in patients undergoing a chlorhexadine scrub (p = 0.13).

A higher rate of persistent swelling was found in patients in whom a post-operative drain was not used (14.2%) versus 6.1% of drained patients (p =0.14). The infection rate between the two groups was not significantly different.

The authors note that infection rates in this study exceed that seen with "clean" (class I) wounds. They therefore suggest that the routine use of prophylactic antibiotics should be encouraged in patients undergoing scrotal surgery. They also recommend that hydrocelectomy and spermatocelectomy should no longer be considered "clean" surgical procedures and may more appropriately be considered "clean-contaminated" procedures, which would help justify the use of perioperative antibiotics.

J Urol. 2004;171:746-8