Immediate Development of Post-Varicocelectomy Hydrocele
Immediate Development of Post-Varicocelectomy Hydrocele
A 29-year-old Caucasian male physician consulted the Department of Urology for his varicocele problem with an abnormal spermiogram. His body weight and height were 79kg and 182cm, respectively. On physical examination, a grade III (GIII) (visible without Valsalva) left-sided varicocele was detected. Testicular volumes were 30mL on the right side and 22.5mL on the left side, as demonstrated by a Prader orchidometer. It was easy to notice a clear difference in the temperature on both sides of the scrotum during scrotal examination; the temperature of the left side was higher. This was also confirmed by the patient, who reported the existence of this temperature difference for many years. He was a single, non-smoker with no history of testicular pain even after a long day. In addition, he had no previous history of any form of scrotal trauma or epididymitis. He had no history of any medical troubles. His semen analysis revealed isolated asthenospermia with otherwise normal semen parameters. He expressed his wish to undergo varicocele repair as a remedy for his asthenospermia and to avoid any further deterioration to his semen parameters. He was also going to get married. Left non-microscopic inguinal varicocelectomy under general anaesthesia was performed by a senior staff member. Two young residents, one of them the first author of this manuscript, attended the surgery for support and training. The cord was identified, and a huge plexus of veins was easily seen even before opening the cord tunics. The vas complex was taken aside. Then, the cord was clamped with two artery forceps, and the segment in between was excised. Ligation of the two cord ends was performed. The testis was not delivered. The whole procedure was completed within 30 minutes with no blood loss.
About seven hours later, the patient left his bed to go to the toilet. Herein, he noticed an enlargement of the left side of his scrotum. He estimated this enlargement to be about three times the 30mL ball in the Prader orchidometer. The swelling was non-tense. He reported the event to the surgical staff on duty. They assured him that this enlargement was just scrotal edema after his surgery, although the scrotal skin could be pinched. They also added that this swelling would disappear within the next few days. He stayed in the ward overnight with an unremarkable course, and left for home the next morning. At home and 72 hours after the surgery, the scrotal enlargement remained the same size. He checked the enlargement himself using transillumination. Light shone through the enlargement and he realized that his swelling was a hydrocele.
During the next years, he lived his daily life as usual. His sperm motility improved. However, the swelling remained the same size. It was always non-tense and painless. He did not try to receive any further treatment due to his first bad experience. Twelve years later, he decided to undergo hydrocelectomy for cosmetic reasons. He consulted us (the authors) with his hydrocele problem. A preoperative ultrasound evaluation showed a huge left-sided hydrocele with multiple internal septa (Figure 1) pushing the homo-lateral testis inferiorly and laterally. He underwent scrotal exploration and hydrocelectomy with excision-eversion of the tunica. The postoperative course was smooth and the pathology report of the tunical specimen was irrelevant. He has not reported any hydrocele recurrence for more than 12 years since this procedure. He never complained of any scrotal pain or discomfort during this period. He was satisfied with the cosmetic image of his scrotum.
(Enlarge Image)
Figure 1.
Scrotal ultrasound image showing multiple septa inside a large left-sided hydrocele sac, pushing the left testis inferiorly and laterally (arrow).
Case Presentation
A 29-year-old Caucasian male physician consulted the Department of Urology for his varicocele problem with an abnormal spermiogram. His body weight and height were 79kg and 182cm, respectively. On physical examination, a grade III (GIII) (visible without Valsalva) left-sided varicocele was detected. Testicular volumes were 30mL on the right side and 22.5mL on the left side, as demonstrated by a Prader orchidometer. It was easy to notice a clear difference in the temperature on both sides of the scrotum during scrotal examination; the temperature of the left side was higher. This was also confirmed by the patient, who reported the existence of this temperature difference for many years. He was a single, non-smoker with no history of testicular pain even after a long day. In addition, he had no previous history of any form of scrotal trauma or epididymitis. He had no history of any medical troubles. His semen analysis revealed isolated asthenospermia with otherwise normal semen parameters. He expressed his wish to undergo varicocele repair as a remedy for his asthenospermia and to avoid any further deterioration to his semen parameters. He was also going to get married. Left non-microscopic inguinal varicocelectomy under general anaesthesia was performed by a senior staff member. Two young residents, one of them the first author of this manuscript, attended the surgery for support and training. The cord was identified, and a huge plexus of veins was easily seen even before opening the cord tunics. The vas complex was taken aside. Then, the cord was clamped with two artery forceps, and the segment in between was excised. Ligation of the two cord ends was performed. The testis was not delivered. The whole procedure was completed within 30 minutes with no blood loss.
About seven hours later, the patient left his bed to go to the toilet. Herein, he noticed an enlargement of the left side of his scrotum. He estimated this enlargement to be about three times the 30mL ball in the Prader orchidometer. The swelling was non-tense. He reported the event to the surgical staff on duty. They assured him that this enlargement was just scrotal edema after his surgery, although the scrotal skin could be pinched. They also added that this swelling would disappear within the next few days. He stayed in the ward overnight with an unremarkable course, and left for home the next morning. At home and 72 hours after the surgery, the scrotal enlargement remained the same size. He checked the enlargement himself using transillumination. Light shone through the enlargement and he realized that his swelling was a hydrocele.
During the next years, he lived his daily life as usual. His sperm motility improved. However, the swelling remained the same size. It was always non-tense and painless. He did not try to receive any further treatment due to his first bad experience. Twelve years later, he decided to undergo hydrocelectomy for cosmetic reasons. He consulted us (the authors) with his hydrocele problem. A preoperative ultrasound evaluation showed a huge left-sided hydrocele with multiple internal septa (Figure 1) pushing the homo-lateral testis inferiorly and laterally. He underwent scrotal exploration and hydrocelectomy with excision-eversion of the tunica. The postoperative course was smooth and the pathology report of the tunical specimen was irrelevant. He has not reported any hydrocele recurrence for more than 12 years since this procedure. He never complained of any scrotal pain or discomfort during this period. He was satisfied with the cosmetic image of his scrotum.
(Enlarge Image)
Figure 1.
Scrotal ultrasound image showing multiple septa inside a large left-sided hydrocele sac, pushing the left testis inferiorly and laterally (arrow).
Source...