Risk of Complications After Hydrocele Surgery: A Retrospective Multicenter Study in Helsinki Metropolitan Area.

BACKGROUND

Despite being one of the most frequent urological procedures, the risk estimates for complications after hydrocele surgery (hydrocelectomy) are uncertain. Decision-making about hydrocelectomy involves balancing the risk of complications with efficacy of surgery-a tradeoff that critically depends on the complication risks of hydrocele surgery.

OBJECTIVE

To examine the 90-d risks of complications of hydrocele surgery in a large, contemporary sample.

DESIGN SETTING AND PARTICIPANTS

We retrospectively reviewed all surgeries performed for nonrecurrent hydroceles conducted in all five Helsinki metropolitan area public hospitals from the beginning of 2010 till the end of 2018, and evaluated the complication outcomes.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

The following outcomes were evaluated: (1) risk of moderate or severe (Clavien-Dindo II-V) hydrocele surgery complications, (2) risk of reoperation due to a surgical complication, and (3) risk of an unplanned postoperative visit to the emergency room or outpatient clinic, all within 90 d after surgery.

RESULTS AND LIMITATIONS

We identified 866 hydrocele operations (38 [4.3%] bilateral operations). A total of 139 (16.1%) patients had moderate or severe hydrocele surgery complications within 90 d after surgery. Of the 139 complications, 94 were (10.9% of all or 67.6% of patients with moderate or severe complications) Clavien-Dindo grade II, 43 (5.0% and 30.9%, respectively) grade III, two (0.2% and 1.4%, respectively) grade IV, and none grade V. A total of 45 patients (5.2% of all and 32.4% of those who had moderate or severe complications) required immediate reoperation due to complications. All together 219 operated patients (25.3% of all operated patients) had an unplanned visit to the emergency room. The retrospective study design limits the reliability of the results.

CONCLUSIONS

Complications after hydrocele surgery are common and warrant further research. These estimates can be useful in shared decision-making between clinicians and patients.

PATIENT SUMMARY

We investigated the complication rates after hydrocele surgery and found that complications are common after a procedure often considered minor: every ninth patient had a moderate and every 20th a severe complication. Every fourth patient had an unplanned postoperative visit to the emergency room.