Incidence and management of hydrocele following varicocele surgery in children

Purpose: Hydrocele seems to be the most frequent complication in children who undergo surgery for varicocele and the issue of the optimal management of hydrocele remains controversial. In this retrospective study we evaluated the incidence and management of hydrocele following surgical treatment of varicocele in children treated at 8 European centers of pediatric surgery. Materials and Methods: In a 5-year period 278 children between 7 and 17 years old underwent surgical treatment for unilateral left varicocele, including 187 using video surgery and 91 via an open inguinal approach. Results: At an average followup of 24 months (range 12 to 60) 34 children (12.2%) had a left hydrocele. Of the 278 children 14 (5%) were lost to followup. The hydrocele appeared between 1 week and 44 months (median 2 months) after surgery. Concerning hydrocele management 16 of 34 children (47%) were treated with scrotal puncture while under local anesthesia, which led to hydrocele regression after a median of 3 punctures (range 1 to 5), 12 (35.3%) underwent clinical observation since the hydrocele reduced spontaneously within a median of 12 months after its appearance and 6 (17.7%) were treated with open surgery. In 4 cases the hydrocele disappeared and in 2 it recurred after surgery and was successfully treated with punctures. Conclusions: This study shows that the median incidence of hydrocele after varicocele surgery is about 12% but it seems higher after artery nonsparing vs sparing procedures (17.6% vs 4.3%)., On the contrary, no difference was found when the procedure was performed using video surgery or with the open approach. Hydroceles generally develop a few months later but may also appear several years after the surgical repair of varicocele. Noninvasive procedures (scrotal punctures or clinical observation) seem to induce total hydrocele regression in more than 82% of cases. Children who undergo surgery for varicocele should undergo long-term followup to detect a possible hydrocele. In fact, the 5.4% of children lost to followup in our study may potentially have had a hydrocele. Surgery is not always successful for this condition, as shown in the 2 cases of recurrent hydrocele after surgical repair.