Percutaneous aspiration for hydroceles after varicocelectomy.

Objectives: To assess the role and efficacy of aspiration alone in the treatment of hydroceles occurring after varicocelectomy. Hydroceles represent one of the most common complications related to varicocelectomy at any age.
Methods: From September 1990 to 2008 at our department, a total of 453 varicocelectomies were performed. Inclusion and exclusion criteria were created. The patients with postoperative hydrocele formation were followed up every 3 months. Aspiration was suggested and then performed after 2 consecutive follow-up visits showing an enlarged hydrocele. In compliance with the protocol implemented at our institution, the clinicians performed >or=3 aspirations before suggesting surgical treatment.
Results: A total of 256 patients were considered for the present study. All patients underwent laparoscopic varicocelectomy, and 31 (11%) developed postoperative hydrocele. Of the 31 patients, 9 (29%) underwent surgical hydrocelectomy after 3 aspirations, 7 (22.5%) had spontaneous resolution of the hydrocele, and 15 (48.5%) were treated with aspiration only. The success rate of aspiration seemed to be related only to the aspirated fluid volume, with <50 mL/aspiration guaranteeing spontaneous resolution in 60% of patients (P <.05).
Conclusions: The results of our study have shown that the management of postoperative hydrocele formation should be conservative for almost 18-24 months, with a minimum of 3 aspirations, if necessary. If confirmed by additional studies, the volume of fluid aspirated from hydroceles could be used as an early indicator of the need for surgery.