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: The purpose of the study is to introduce our experience of a modified single-port minilaparoscopic technique for the treatment of pediatric hydrocele. Between June 2008 and May 2012, 279 boys (115 communicating hydrocele and 164 "non-communicating" hydrocele, diagnosis based on preoperative physical examination and scrotal ultrasound) underwent the modified single-port minilaparoscopic repair in our institution. During surgery, a 3-mm laparoscope was inserted into the abdomen through a mini-umbilical incision. The hydrocele sac orifice was closed by an extraperitoneal purse-string suture placed around the internal ring with an ordinary taper needle and an endoclose needle. Of all the 279 patients, 16 (5.7 %) were found to have a potential patent processus vaginalis (PPV) on the contralateral side. Of the 164 boys diagnosed with "non-communicating" hydrocele preoperatively, 5 (3.0 %) had no PPV identified in laparoscope and the other 159 (97.0 %) had PPV actually. A total of 274 single-port minilaparoscopic procedures were performed, and all cases were successful without serious complications. The mean operative time was 19.5 and 24.8 min for unilateral and bilateral operations, respectively. Postoperative complications were noted in 4 cases, 2 (0.7 %) patients with scrotal edema, 1 (0.4 %) patient experienced an umbilical hernia, and 1 (0.4 %) patient with suture site abscess. During a median follow-up period of 9 months (range 6-24 months), postoperative hydrocele recurrence was seen in 2 patients (0.7 %). This modified single-port minilaparoscopic technique is a safe, effective, and reliable procedure for pediatric hydroceles.World Journal of Urology 02/2014; · 2.89 Impact Factor
Article: New minimally access hydrocelectomy.[Show abstract] [Hide abstract]
ABSTRACT: To ascertain the acceptability of minimally access hydrocelectomy through a 2-cm incision and the outcome in terms of morbidity reduction and recurrence rate. Although controversy exists regarding the treatment of hydrocele, hydrocelectomy remains the treatment of choice for hydroceles. However, the standard surgical procedures for hydrocele can cause postoperative discomfort and complications. A total of 42 adult patients, aged 18-56 years, underwent hydrocelectomy as an outpatient procedure using a 2-cm scrotal skin incision and excision of only a small disk of the parietal tunica vaginalis. The operative time was 12-18 minutes (mean 15). The outcome measures included patient satisfaction and postoperative complications. This procedure requires minor dissection and minimal manipulation during treatment. It also resulted in no recurrence and minimal complications and required a short operative time.Urology 02/2011; 77(2):487-90. · 2.42 Impact Factor
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ABSTRACT: A number of pathologies can present as groin swellings in adults.Among these, encysted hydrocele of the cord presenting as swelling in an adult is a rare. A case of encysted hydrocele of cord in 36 year old male mimicking as as an irreducible hernia is reported. The diagnosis of hydrocele was made intraoperatively. An excision of the sac was performed.Oman medical journal. 07/2009; 24(3):218-9.
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.
1. Roland RG,Foster RS,Donohue JP. Scrotum and testis. In:
Adult and Pediatric Urology.Gillenwater JY,Grayhack JT,Howards
SS et al(eds).Mosby-Year book,Inc 1996; 1907-49.
2.Tanagho EA, McAninch JW: Disorders of the spermatic cord.
In: Smith’s General Urology.Tanagho EA,McAninch(eds).Lange
Medical books.New York. 1992; 620-3.
3.Sivam NS, Jayanthi S, Ananthakrishnan N, Elango A, Yuvaraj
J, Hoti SL, et al. Tropical vaginal hydroceles. Are they all
filarial in origin? Southeast Asian J Trop Med Public Health
4. Ku HJ, Kim ME, Lee NK, Park YH. The excisional, placation
and internal drainge techniques: a comparison of the results
for idiopathic hydrocele. BJU Int 2001;87:82-4.
5.Akpo EE: Giant Hydrocele.
6.Ananthakrishnan N, Pani SP. Surgery for vaginal hydroceles:
an update. Indian J Urol 2005;21:35-38
7.Kar SK, Mania J: Filarial hydrocele and its treatment with
DEC. Progress in Lymphology. XIV. In: Proceedings of the XIV
International Congress of Lymphology: Washington, DC; 1993;
8. Bernhard P, Magnussen P, Lemnge MM. A randomized,
diethylcarbamazine for the treatment of hydrocele in an area
of Tanzania endemic for lymphatic filariasis. Trans R Soc Trop
Med Hyg 2001;95: 534-6.
9. Albrecht W. Holtl W, Aharinejad S. Lord’s procedure - the
best operation for hydrocele. J Urol 1991;68:187-9.
10. Hass JA, Carrion HM, Sharkey J, Politano VA. Operative
treatment of hydrocele: another look at Lord’s procedure.
11. Fuchs, E.F. Cordal block anaesthesia for scrotal surgery. J.
Urol.1982., 128, 718–19.
12. Bannister L.H, and Dyson M. Reproductive organs of the
male. In Gray’s Anatomy. Williams P.L. (ed.) 38th edn. Churchill
Livingstone, London.1995 pp. 1848–1861
13. Kaye KW, Clayman RV, Lange PH: Outpatient hydrocele and
spermatocele repair under local anesthesia. : J Urol.
14. Pani SP, Balakrishnan N, Srividya A, Bundy DA, Grenfell BT:
Clinical epidemiology of bancroftian filariasis. Effect of age
and gender. Trans R Soc Trop Med Hyg 1991;85:260.
15. Craft I. & Tsirigotis M: Simplified recovery, preparation and
cryopreservation of testicular spermatozoa. Hum
16. Mallidis C. & Baker HWG: Fine needle tissue aspiration
biopsy of the testes. Fertil. Steril.1994,61, 367-75.