Hydrocelectomy under local anaesthesia in a Nigerian adult population.
ABSTRACT Hydrocele is abnormal collection of serous fluid in the tunica vaginalis or a patent processus vaginalis. It is commonly encountered in our practice and often requires surgical treatment. However in our setting and in many underdeveloped countries, availability of general anaesthetic service is poor due to lack of trained personnel and equipment.
To ascertain the practicability and acceptability of hydrocelectomy under sedation and local anaesthesia in Nigerian adults with hydrocele
A prospective study was carried out over a two year period on patients that had hydrocelectomy at the surgery unit of the Obafemi Awolowo University Teaching Hospitals Complex, Wesley Guild Hospital, Ilesa. Consecutive patients with diagnosis of hydrocele who consented had hydrocelectomy using intramuscular diazepam sedation and spermatic-cord block with 0.5% plane xylocaine and the scrotum infiltrated with same along the line of incision.
Fifty adult patients were studied: age range 15-94 years. Eighty percent of the patients had unilateral hydrocele and the commonest type was vaginal hydrocele (94%). All patients had hydrocelectomy, 96% were under local anaesthesia while 4% were converted to general anaesthesia. All patients except one prefer to have future surgery under such local anaesthesia and sedation.
Hydrocelectomy under local anaesthesia and sedation is practicable and was tolerated and accepted by the adults patients studied.
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ABSTRACT: Hydrocele of the tunica vaginalis testis has been conventionally used as an absolute indicator of filarial disease in most clinical surveys. The prevalence of filarial etiology in 100 consecutive hydroceles was studied using clinical, parasitological, histopathological and immunological parameters. Filarial etiology could be proved in 57% of hydrocele cases using major criteria: presence of microfilaria in hydrocele fluid, presence of chyle in hydrocele fluid, demonstration of adult worm in tunica, ratio of fluid antibody titer to serum antibody titer more than 2 and presence of filarial antigen in hydrocele fluid. The results of other tests in these 57 cases were used to define the minor criteria. In the other 43 cases, based on the minor criteria, 12 hydroceles could be classified as likely to be due to filariasis and the rest were probably non-filarial. Thus only 69% of hydroceles were definitely or probably filarial.The Southeast Asian journal of tropical medicine and public health 01/1996; 26(4):739-42. · 0.61 Impact Factor
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ABSTRACT: In men, vaginal hydrocele is the most common morbidity due to Wuchereria bancrofti . Diagnosis is straightforward most of the time but when the swelling is not transilluminant, patients in whom the diagnosis is in doubt, children with hydroceles and those with co-morbid conditions should have ultrasonography to differentiate these swellings. Studies on the effect of medical treatment with diethylcarbamazine on the size of hydroceles are inconclusive. The only effective treatment for hydrocele is surgery as the minimally invasive therapy like aspiration and sclerotherapy are known to have high recurrence rates. Several surgical options are available for managing hydrocele but the recommended operation is hydrocelectomy, i.e. a subtotal excision of the parietal layer of the tunica vaginalis leaving a rim of approximately one-centimeter width around the testis and epididymis.Indian Journal of Urology. 01/2005;
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ABSTRACT: Hydrocoele is common in men in Wuchereria bancrofti-endemic areas, the treatment for which is currently surgical intervention. Two community studies have recently suggested that the antifilarial drug diethylcarbamazine (DEC) may have a beneficial effect of reducing the size of hydrocoeles of filarial origin. To test this hypothesis, a double-blind, placebo-controlled study was carried out in 1998 and 1999 in an area of north-eastern Tanzania where microfilaria (mf) carrier rates and hydrocoele prevalence rates were known to be high. Ninety-eight adult male volunteers (aged > or = 15 years) with chronic hydrocoele received DEC 300 mg per day for 12 days (49 patients), or placebo (49 patients). Circumferential and ultrasonographic measurements of the scrotum, and a serum sample for measuring W. bancrofti antigen, were obtained at the onset and after 3, 6 and 12 months. Scrotal size and hydrocoele fluid volume indices were calculated. No statistically significant differences in volumetric measurements between the DEC and placebo groups were found at any of the follow-ups. Separate analyses dividing patients by antigen status, hydrocoele size or presence of thickening of the scrotal skins gave similar results. Geometric mean intensity of W. bancrofti antigen was significantly lower in the DEC group than in the placebo group (P = 0.008), indicating that lack of compliance was not a significant factor. Two months into the treatment trial, mass treatment with monthly low-dose DEC was given to the rest of the community. We conclude that DEC is not effective in reducing the size of hydrocoele of filarial origin. Interventions to replace or supplement hydrocoelectomy should be investigated.Transactions of the Royal Society of Tropical Medicine and Hygiene 01/2001; 95(5):534-6. · 1.82 Impact Factor
African Health Sciences Vol 8 No 3 September 2008160
Hydrocelectomy under local anaesthesia in a Nigerian adult
Agbakwuru EA, Salako AA, Olajide AO, Takure AO, *Eziyi AK
1 Department of Surgery, Obafemi Awolowo University Teaching Hospital, Ile Ife, Osun State. Nigeria. 2 *Department of
Surgery, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State. Nigeria.
Background : Hydrocele is abnormal collection of serous fluid in the tunica vaginalis or a patent processus vaginalis. It is commonly
encountered in our practice and often requires surgical treatment. However in our setting and in many underdeveloped countries,
availability of general anaesthetic service is poor due to lack of trained personnel and equipment.
Objectives: To ascertain the practicability and acceptability of hydrocelectomy under sedation and local anaesthesia in Nigerian
adults with hydrocele
Patients and Methods: A prospective study was carried out over a two year period on patients that had hydrocelectomy at the
surgery unit of the Obafemi Awolowo University Teaching Hospitals Complex,Wesley Guild Hospital, Ilesa. Consecutive patients
with diagnosis of hydrocele who consented had hydrocelectomy using intramuscular diazepam sedation and spermatic-cord block
with 0.5% plane xylocaine and the scrotum infiltrated with same along the line of incision.
Results: Fifty adult patients were studied: age range 15-94 years. Eighty percent of the patients had unilateral hydrocele and the
commonest type was vaginal hydrocele (94%). All patients had hydrocelectomy, 96% were under local anaesthesia while 4% were
converted to general anaesthesia. All patients except one prefer to have future surgery under such local anaesthesia and sedation.
Conclusion: Hydrocelectomy under local anaesthesia and sedation is practicable and was tolerated and accepted by the adults
Key words: Hydrocele, hydrocelectomy, local anaesthesia,sedation
African Health Sciences 2008; 8(3): 160-162
Hydrocele is a collection of serous fluid in the tunica
vaginalis or a patent processus vaginalis. It may arise in
the spermatic cord in the males or canal of Nuck in the
females.1,2 Hydrocele is idiopathic in most cases but in
some cases may be secondary to various pathologies like
infections (orchitis, epididymitis, tuberculosis or
filariasis), testicular torsion, tumour or trauma.3,4 The
diagnosis is essentially clinical, but where doubt exists,
scrotal ultrasound can be used to differentiate it from
other scrotal lesions5,6.Controversies exists about the
treatment of hydrocele; aspiration of the fluid and
injection of sclerosants has been described, this is
however associated with high rate of infection and
recurrence4,5.Some workers have described the use of
di-ethylcarbamazine in the treatment of hydrocele due
to filariasis.7,8 However, hydrocelectomy remains the
treatment of choice for the management of
hydroceles.4,9,10 Hydrocelectomy can be done under
general or local anaesthesia using either bupivacaine or
lignocaine11,12,13. The advantages of this method include
cost reduction, alleviation of the risks associated with
general anaesthesia and suitability for patients who have
co-morbid medical conditions or are afraid of general
anaesthesia.Consideration of safety and cost-
effectiveness by many of our patients also argue strongly
for performance of most hydrocele repairs as outpatient
procedures under local anesthesia.13 In this study, we
assess the practicability of hydrocelectomy as a day-case
procedure under local anaesthesia using spermatic cord
block and intramuscular diazepam sedation and evaluate
the acceptability of this procedure in Nigerian adult
patients with hydrocele.
Patients and methods
Fifty consecutive adult patients, age above fifteen years,
with diagnosis of hydrocele,small and moderate sized,
excluding giant hydroceles(big as the patients head)
underwent hydrocelectomy as day case procedure with
local anaesthesia using spermatic cord block and scrotal
skin infiltration with local anaesthetic,0.5% plane
lignocaine and intramuscular diazepam sedation.
Intramuscular diazepam 10mg was given 30mins before
commencement of the surgery. Thereafter spermatic
Urology Unit, Department of Surgery,
Obafemi Awolowo University Teaching Hospital,
Ile Ife, Osun State, Nigeria.
African Health Sciences Vol 8 No 3 September 2008
cord block was done by the assistant holding the
spermatic cord gently between the fore finger and
thumb both at the inguino-scrotal junction and just above
the scrotum in order to stabilise the spermatic cord. 10
mls of 0.5% plane lignocaine (constituted by diluting
2% lignocaine with three times volume of normal saline)
was injected around the stabilized spermatic cord at three
different angles using size 23G needle, each done
without completely withdrawing the needle through the
skin. Before injecting, the plunger of the needle was
aspirated to avoid inadvertent intravascular injection of
the local anaesthetic. Thereafter, scrotal skin and
subcutaneous tissue at the site of the incision were
infiltrated with 5 – 10mls of same reconstituted
lignocaine solution after a negative aspiration test.Patients
with giant hydrocele were treated with general or spinal
Hydrocelectomy proceeded 3–5minutes later
using either the Jaboulay’s or Lord’s method4,9,1O as
appropriate, after ensuring satisfactory local anaesthesia
by stimulating the infiltrated skin with toothed dissecting
forceps. Communication was maintained with the
patients throughout the period of the operation and the
patients were questioned or observed for subjective
symptoms of local anaesthetic complications or pain.
Pain score was assessed using 4 point categorical verbal
score (0=no pain, 1=mild pain, 2=moderate pain,
3=severe pain) from the time of the incision,midway
and at the end of the procedure. The wounds were
dressed with scrotal support and the patients were
discharged 2 – 3hrs after the procedure. They presented
for wound inspection and change of wound dressing on
post operative day three and for removal of stitches on
the post operative day seven. However, they were to
present earlier if there was any complaint before the
appointment day. Patients’ satisfaction with the treatment
was assessed on the post operative day seven on a scale
of 1 – 4 (1=very satisfied, 2=satisfied, 3=dissatisfied,
Fifty consecutive adult patients were studied. The age
ranged between 15 and 94 years with mean age of 62
years. Eighty percent of these patients were above 50years.
(Table1). Most of the patients presented late with
41patients (82%) presenting after 1 year of onset of the
scrotal swelling.Eighty percent (80%)were unilateral
with almost equal frequency of occurrence on both sides
(38% left and 42% right). Bilateral disease was found in
20% of the patients. All the cases were non-
communicating with vaginal hydrocele being the
commonest (94%), encysted hydrocele constituting 4%
and infantile hydrocele 2%(sac extended to external
inguinal ring,but non communicating with peritoneal
cavity). Forty (80%) of the patients had Jaboulay’s
procedure done while eight (16%) had Lord’s
procedure and two (4%) had excision of encysted
hydrocele of the cord. The complications recorded are
haematoma in 4 patients (8%), and wound infection in 3
patients (6%) (Table 2), all of whom were managed
Table 1: Age Distribution
Age Range Frequency
Table 2: Patients’ tolerance of the procedure
No pain 32
Mild pain 14
Moderate pain 2
Severe pain 2
All the patients had the procedure using local anaesthesia
as described in the method,thirty two patients( 64% )
had no complain throughout the period of the operation,
fourteen patients( 28%) had feeling of pressure or
pulling sensation (mild pain), two(4%) had pain referred
to the lower abdomen but could still tolerate this
(moderate pain) and preferred to have the operation
completed under local anaesthesia. Another two ( 4%)
had severe pain which they could not tolerate and
preferred conversion to general anaesthesia, both of
whom were not given diazepam because they were
elderly (above 80years) with poor cardio-pulmonary
reserves as determined by the attending physician
preoperatively (Table 2). All the patients were discharged
home within 4 hrs of the procedure except the 2 cases
converted to general anaesthesia that stayed on admission
for 48 hrs. None of the patients had complaint serious
enough to seek consultation before the appointment
days and all were satisfied with the treatment on final
review and all except one will prefer local anaesthesia
for future surgeries because of the severe pain
necessitating conversion to general anaesthesia.
African Health Sciences Vol 8 No 3 September 2008162
Forty (80%) of the patients in this series were older
than 50 years with the mean age of 62 years and 22% of
the patients were farmers. This is not surprising since
hydrocele resulting from orchitis, epididymitis or
tropical infections such as filariasis causing either
excessive secretion from irritation of tunical vaginalis or
reduced drainage from lymphatic obstruction occur in
the adults14,15 All the patients in this study presented
with painless scrotal swelling and their reasons for
seeking treatment was the weight of the scrotum causing
dragging sensation and the cosmetic considerations of
The majority of the patients were asymptomatic
and hence presented with duration greater than a year1,2
The complications were not different from those of
scrotal surgery performed under general anaesthesia and
they were managed conservatively on out-patient basis.
Doing this procedure under local anaesthesia reduced
the cost of treatment to 50-70% of what in-patient
hydrocelectomy under general anaesthesia would have
been.13 The risks associated with admission and general
anaesthesia in the elderly is eliminated. There is also no
need for starvation post operatively and the patients have
the benefit of domiciliary care with the comfort of
staying with their relatives while recovering.
Patients that are afraid of general anaesthesia,
and who would have preferred to endure their ailment
than risk general anaesthesia readily find solace in local
anaesthesia. In addition a surgeon will be more
comfortable with this method when the patient is an
elderly with some co-morbid conditions which may
increase the risk of general anaesthesia. This has made
several authors to recommend local anaesthesia for many
scrotal surgeries including testicular biopsy, aspiration
of spermatozoa, spermatocelectomy
hydrocelectomy.6,13,16 The use of an anxiolytic agent like
diazepam as pre-medication for local anaesthesia in day
care procedure can reduce fear and anxiety, the pain and
allow the patient to cooperate with the surgeon during
surgery.16 All the patients were satisfied with the
outcome of their treatment at the last review and 98%
prefer local anaesthesia for subsequent procedure.
In this study, all patients who consented to
hydrocelectomy were included. A randomized
controlled trial would have been a better design to avoid
bias in the results. However,many of these patients were
either afraid of general anaesthesia or had co-morbid
conditions that may increase the risk of general
Hydrocelectomy under local anaesthesia is practicable
and was tolerated and accepted by the adult patients
We thank the consultant surgical staff of the Wesley
Guild Hospital for their co-operation. We thank Mrs
Funmi Ogunwo for the secretarial assistance.
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