Sclerotherapy for hydroceles

Sclerotherapy with 3% sodium tetradecyl sulfate and 3.5% rolitetracycline on an outpatient basis was applied to 55 hydroceles. The over-all cure rate was 96% with an average followup of 13 months. Of the patients 64% were cured after only 1 sclerosant instillation. A post-sclerotherapy operation was necessary in 4% of the patients. Pain of a significant degree occurred after sclerotherapy in only 29% of the patients. Sclerotherapy appears to be an effective, economical and safe form of outpatient therapy for hydroceles.     

Sclerotherapy of hydroceles with polidocanol

Fifteen patients with hydroceles of the testis or spermatic cord were treated by aspiration and injection of the sclerosant solution polidocanol. The cure rate of hydroceles after one sclerotherapy session was 73%, and the overall cure rate using the procedure was 87%. No patient experienced pain during or after the procedure, which was conducted without anaesthesia. No complications were observed. It is concluded that sclerotherapy of hydroceles with polidocanol may be a useful alternative to open operation, due to its ease of administration, low frequency of complications, and high rate of effectiveness, and that this agent is preferable to certain other drugs in that it causes no pain during or after the injection.     

Dose- and Time-Dependent Liquid Sclerosant Effects on Endothelial Cell Death

BACKGROUND: Intravenous sclerotherapy solutions can induce endothelial cell death. OBJECTIVE: The objective was to determine the relationship between sclerosant concentration and minimum contact time required for in endothelial cell death. METHODS: Cultured bovine aortic endothelial cells were exposed to a broad range of concentrations of two liquid sclerosants, polidocanol and sodium tetradecyl sulfate. Fluorescence microscopy was used to study cells using dyes specifically indicating changes in intracellular calcium levels, nitric oxide production, and loss of cell membrane integrity after sclerosant exposure. Fluorescence intensity measurements were used to identify the timing of cell death. RESULTS: Calcium signaling and nitric oxide pathways were activated by the administration of the sclerosants and were followed by cell death. The time to the activation and the cell death was dependent on the concentration of sclerosants. At 0.3% polidocanol or 0.1% sodium tetradecyl sulfate, cell death occurred within 15 minutes. At less than 0.003% polidocanol and at 0.005% sodium tetradecyl sulfate, cells remained alive after 60 minutes. CONCLUSION: Both sclerosants rapidly led to cell death at sufficiently high concentrations. At low sclerosant concentrations, cell viability was maintained beyond the recording time of the experiment. The timing of endothelial cell death is predictable based on sclerosant concentration during exposure.     

COST-EFFECTIVE HYDROCELE ABLATION

Purpose

The surgical repair of hydroceles can be relatively expensive in some in terms of costs and initial limitation of activity. We ascertain whether aspiration and sclerotherapy of hydroceles is a safe, efficient, cost-effective treatment modality in select patients.

Materials and Methods

In 47 patients 51 hydroceles were treated in the office with aspiration and instillation of a sclerosing solution based on a sodium tetradecyl sulfate preparation. One treatment was done in 14 cases and 2 in the remainder. Medicare data for 1995 were used for charge analysis.

Results

The overall success rate was 61% (34 of 51 cases) with success defined as no perceptible ipsilateral scrotal fluid reaccumulation on palpation by a physician and complete patient satisfaction. The failure rate was 39% (17 cases) with failure defined as perceptible ipsilateral scrotal fluid reaccumulation on palpation by a physician and/or patient dissatisfaction. The charge differential of surgery versus aspiration and sclerotherapy was greater than 9:1.

Conclusions

The aspiration and sclerotherapy technique that we used appears to be an efficacious, safe, cost-effective treatment modality in select patients with idiopathic hydroceles.     

Comparative potency of atropine sulphate and glycopyrrolate on heart rate in man

Disagreement as to the effect of glycopyrrolate and atropine sulphate at various dosages on heart rate has been reported in the literature. Of particular interest is the question of whether small doses of glycopyrrolate cause bradycardia. Three groups of subjects were studied. The QRS complexes of the electrocardiogram were continuously recorded on a microcomputer. Group 1 consisted of 10 healthy volunteers who were given two doses of atropine sulphate 1.25 micrograms kg-1 and glycopyrrolate 0.75 micrograms kg-1, in random order at two different times, i.v. Monitoring continued until heart rate returned to baseline. Group 2 consisted of 24 women, ASA class I or II, scheduled for gynaecological operations. Each patient received fractionated i.v. doses of either atropine sulphate 2.5, 2.5 and 5 micrograms kg-1 or glycopyrrolate 1.5, 1.5 and 3.0 micrograms kg-1 at 3-min intervals. Heart rate was measured continuously for 1 h before drug injection and for 10 min after the last dose. Group 3 consisted of six volunteers given both drugs in the same dose and time schedule as Group 2, but heart rate was monitored for 180 min after the last dose. In Group 1, the incidence of bradycardia and increases in heart rate after the first dose were statistically significant for both atropine sulphate and glycopyrrolate when compared with baseline values. In Group 2, both drugs significantly increased the heart rate and had similar times to peak effect. In Group 3, bradycardia occurred only with atropine sulphate. Increases in heart rate, peak heart rate and duration of action were similar with both drugs.(ABSTRACT TRUNCATED AT 250 WORDS)     

Comparison of ethanol and sodium tetradecyl sulfate in the sclerotherapy of renal cyst

BACKGROUND AND PURPOSE: Renal cysts are common in the adult population. Symptomatic cysts traditionally have been treated by percutaneous aspiration with injection of sclerosant agents. Our aim was to compare the efficacy and side effects of ethanol and sodium tetradecyl sulfate (STDS) as sclerosants for symptomatic simple renal cyst. PATIENTS AND METHODS: Sixty-five patients with 68 symptomatic simple renal cysts were included in this study. An 8F pigtail catheter was inserted into the cyst under ultrasound guidance followed by aspiration of the cyst fluid. Either 95% ethanol (N = 34) or 3% STDS (N = 34), assigned randomly, was then instilled into the empty sac. Patients recorded any flank pain on a visual analog scale and were followed up by ultrasonography for 6 to 18 months. RESULTS: There was complete ablation of 28 (82%) and 26 (76%) cysts, partial regression of 3 (9%) and 6 (18%) cysts, and failure of treatment in 3 (9%) and 2 (6%) cysts in the ethanol and STDS groups, respectively. There was no major complication in either group. The pain caused by the injection was significantly less for the group receiving STDS (pain score 2.1 +/- 1.1 v 3.8 +/- 1.2 for ethanol; P = 0.019). CONCLUSIONS: Ethanol and STDS are simple, noninvasive, cost-effective, and well-tolerated sclerosants for the treatment of simple renal cysts. We prefer STDS as a first choice because it causes less pain.     

Aspiration and tetracycline sclerotherapy of hydroceles

Aspiration and sclerotherapy of hydroceles have been considered an effective outpatient procedure. We report on our experience with modification of this procedure in the treatment of 28 hydroceles. A 10 per cent solution of tetracycline hydrochloride was used as the sclerosant. In this series the mean followup was 15 months and there was an over-all 93 per cent success rate. A single treatment was successful in 75 per cent of the hydroceles. Complications included a hematoma in 2 patients and epididymitis in 1. We consider aspiration and sclerotherapy of hydroceles to be a reasonable alternative to an operation.     

LONG-TERM EXPERIENCE WITH SCLEROTHERAPY FOR TREATMENT OF EPIDIDYMAL CYST AND HYDROCELE

Background: Symptomatic testicular hydrocele and cyst of the epididymis may be treated with either operation or sclerotherapy. Methods: The current report presents the experience of a 9 year prospective study using sodium tetradecyl sulphate (STD) sclerotherapy for the treatment of symptomatic hydrocele and/or epididymal cyst. Results: A total of 102 lesions were treated during the study period, with an initial success rate of 76% which improved to 94% with multiple treatments. The overall median follow up during the study was 30 months (range 2–100). Conclusions: Sclerotherapy offers a cost-effective outpatient method for the treatment of symptomatic scrotal cysts.     

Tetracycline sclerotherapy of hydroceles and epididymal cysts. Long-term results

Fourty patients with 32 hydroceles and 11 epididymal cysts were treated by aspiration and instillation of tetracycline. After a follow up period of 24-39 months the cure rate was 77%. Most of the early recurrences were the results of chemical inflammation and vanished spontaneously. This group should therefore not be operated on until three months after their initial treatment. As aspiration of the fluid had allowed palpation of the testis and cytological examination, only a small proportion of patients with recurrences wanted further treatment. We therefore recommend tetracycline sclerotherapy because it is quick, easy, safe, and effective in the long as well as the short term.     

0.5% polidocanol for treatment of varicose veins

Background: The use of sclerosants approved by the US Food and Drug Administration for treatment of varicose veins, including sodium morrhuate, ethanolamine oleate, and sodium tetradecyl sulphate, has resulted in complications that include allergic reactions and occasional deaths. Polidocanol, which has not been approved by the Food and Drug Administration, has been well studied and well described in the literature as a safer, more effective sclerosant for varicose veins at 3.0% concentration. Objective: The purpose of this study was to examine the efficacy of 0.5% polidocanol as a sclerosant for varicose veins. Methods: A test dose of polidocanol is injected 1 week before the start of treatment to test for allergic response. Sclerotherapy sessions last 10 minutes, and an average of 10 to 20 mL of 0.5% polidocanol is injected through use of 30-gauge half-inch tuberculin syringes. The treated varicosities are compressed with Coban wrap and compression hosiery for 48 hours after treatment and with compression hosiery alone for another 2 weeks. Results: Having performed approximately 1600 sclerotherapy sessions using 0.5% polidocanol over the last 6 years, I have observed that an average of 3 sclerotherapy sessions are required to attain an 80% to 85% improvement in varicose veins. The number of sessions required for successful treatment ranged from 1 to 15. Results have been long lasting. Localized thrombus formation and hyperpigmentation occurred in some degree in every treated patient but generally did not require treatment for resolution. No ulcerations, pulmonary emboli, or anaphylactic reactions were observed. Superficial chemical thrombophlebitis occurred in 3 patients. Conclusions: Polidocanol is a painless, nonscarring, effective treatment for a condition that previously has been treated surgically. The minimal sclerosant concentration for the treatment of varicose veins is 0.5%.     

New onset of hydroceles in boys over 1 year of age

AIM: The presentation, and medical and surgical management of all new onset non-congenital hydroceles in boys older than 1 year of age were examined. Of particular interest was the outcome of those patients who presented with a non-communicating hydrocele that developed after the first year of life and was managed conservatively. METHODS: All patients older than 12 months of age who were evaluated as outpatients with the diagnosis of hydrocele from January 1994 to January 2001 were identified. Possible risk factors and predisposing conditions were determined. For the patients who had surgical correction, surgical indications were identified. For non-surgical patients, long-term outcomes were recorded. RESULTS: A total of 302 patients older than 12 months of age with the diagnosis of new onset hydrocele were identified. Of these, 35% were non-communicating, 59% were communicating, and 6% were hydroceles of the spermatic cord. In terms of surgery, 97% of communicating hydroceles, 71% of hydroceles of the spermatic cord, and 34% of non-communicating hydroceles had operative management. Seventy patients with non-communicating hydroceles did not receive surgery and 51 (73%) were contacted for long term follow-up. In these 51 patients, 76% of non-communicating hydroceles resolved completely, 6% decreased in size but were still present, 14% remained the same size, and 4% had an unknown status. The average time to resolution was 5.6 months with a median time of 3 months. The time range to resolution was from 1 day to 24 months. Follow-up averaged 73.7 months with a range of 33 to 120 months. CONCLUSIONS: Approximately 75% of new onset, non-congenital, non-communicating hydroceles resolve spontaneously irrespective of size. An observation period of 6-12 months would be appropriate prior to repair.     

A study of the local toxicity of agents used for variceal injection sclerotherapy

Injection sclerotherapy is widely used in the treatment of oesophageal varices. However, few studies have compared the local toxicity of sclerosant agents which may be important if serious local complications are to be avoided. In this study the depth of injury caused by submucosal injection of increasing concentrations of sodium tetradecyl sulphate, polidocanol, 5% ethanolamine oleate and 5% varicosid in rabbits stomach, has been compared by histopathological examination. Macroscopic ulceration was seen in 14.6% of injection sites. Increasing concentrations of sodium tetradecyl sulphate and polidocanol produced increasingly extensive microscopic inflammation. Five percent varicosid caused more inflammation than 5% ethanolamine and only 3% polidocanol and 5% varicosid caused full thickness inflammation. Only 5% ethanolamine produced inflammation consistently confined to the mucosa and submucosa. On the basis of this study we feel that 5% ethanolamine is the most suitable agent for injection sclerotherapy.     

PERCUTANEOUS ASPIRATION AND SCLEROTHERAPY FOR TREATMENT OF SPERMATOCELES

PURPOSE: Spermatoceles are commonly treated with open surgical ablation. With the increasing shift towards minimally invasive surgery and heightened awareness, both patient and surgeon accept and prefer the less intrusive approach. Treatment of spermatoceles translates into the use of aspiration and sclerotherapy rather than open excision. We report on our prospective study of percutaneous aspiration and sclerotherapy with sodium tetradecyl sulfate for treatment of spermatoceles to determine safety, efficacy and cost-effectiveness. MATERIALS AND METHODS: Patients with symptomatic cystic scrotal lesions were prospectively enrolled in an aspiration and sclerotherapy protocol between October 1998 and June 2000. All patients underwent aspiration followed by sclerotherapy with a sodium tetradecyl sulfate solution. Followup included clinical assessment and scrotal ultrasonography at 12 weeks and on a needed basis thereafter. RESULTS: A total of 28 patients with 34 spermatoceles were enrolled in the protocol. Mean patient age was 61.0 years and mean spermatocele volume was 89.3 ml. Complete followup was available for 31 of 34 (91%) spermatoceles, and the mean duration of followup was 24.6 weeks. Results were cure in 29% success in 36%, partial success in 19% and failure in 16% of cases. Patient satisfaction was 85% and there were no complications. The total cost of each procedure was only $104 (Canadian), and none took more than 10 minutes. CONCLUSIONS: Percutaneous aspiration and sclerotherapy with sodium tetradecyl sulfate is a minimally invasive, simple, safe, inexpensive and reasonably efficacious treatment option for spermatoceles. Initial failures can be salvaged with second treatment.     

Chylothorax as a complication of oesophageal sclerotherapy.

Chylothorax is an unusual complication of sclerotherapy for oesophageal varices. A patient is described in whom a massive chylous effusion followed sclerotherapy with repeated injections of 1.5% sodium tetradecyl sulphate. The thoracic duct traverses the posterior mediastinum in close proximity to the oesophagus, and may be disrupted by injections at mid oesophageal level.     

The effectiveness of sodium tetradecyl sulfate in the treatment of wrist ganglia

BACKGROUND

Ganglia are the most common benign soft tissue tumours of the hand. Although benign, a significant number of patients with wrist ganglia consult with their general practitioners, and ultimately the hand surgeon, complaining of pain. A great number of patients are concerned about the cosmetic appearance, and an equally significant number genuinely believe that the ganglion is a cancer. There are several management options resulting in varying degrees of success. These include observation only, surgical excision, aspiration only, aspiration with injection of methylprednisolone, and aspiration with injection of methylprednisolone and hyaluronidase.

OBJECTIVE

The main objective was to investigate the effectiveness and safety of sodium tetradecyl sulfate as a sclerosing agent after aspiration of wrist ganglia.

METHODS

Initial data were collected prospectively during a period of 48 months. Following this, patients were sent a postal survey at least two years after they had received treatment to access the levels of recurrence and persistent complications.

RESULTS

In the short term, 90% of the patients achieved complete resolution after one episode of aspiration and injection. However, there was only a 65% cure rate after two to five years. Complications were few and not significant.

CONCLUSION

Sodium tetradecyl sulfate is an effective sclerosing agent after aspiration of wrist ganglia with an excellent short-term efficacy and a long-term cure rate comparable to that of surgical excision.     

Ethanolamine oleate sclerotherapy for hydroceles and spermatoceles: a survey of 158 patients with ultrasound followup.

Sclerotherapy with 5% ethanolamine oleate was used to treat 102 hydroceles in 100 patients and 63 spermatoceles in 58 patients. Scrotal ultrasound examination was performed before the sclerotherapy and at each followup visit. Of the hydroceles 98% were cured completely and 68% were cured after only 1 sclerosant instillation, while 60% of the spermatoceles resolved completely and 33% partially, with 7% failures. No hydroceles recurred during an average followup of 43 months, whereas spermatocele recurred in 4 patients more than 1 year after successful treatment, with a mean followup of 46 months. Approximately half of the patients experienced pain after treatment, 3 had infection and 2 had hematoma. No changes in the structure or size of the testicles were found by ultrasound during followup. Ethanolamine oleate sclerotherapy is a safe, effective and economical form of outpatient therapy that can be recommended as primary treatment for hydroceles in adults and as an alternative to surgery for spermatoceles with 1 to 3 cysts in elderly men in whom fertility is not important.     

Does pleurodesis for pleural effusions give bright ideas about the agents for hydrocele sclerotherapy?

Objective: Evaluation of the effectiveness of rifampicin and some agents used in the pleurodesis of pleural effusions, such as autologous blood and purified mineral talc.Patients and methods: A total of 56 hydroceles were treated by sclerotherapy, in a random fashion, using purified mineral talc, rifampicin and autologous blood as sclerosant agents. The control group of patients were handled with aspiration only.Results: The cohort of patients in the blood group had a success rate comparable to the control group (p > 0.05). the rifampicin group did better than both control and blood groups (p < 0.05) but not better than the talc group (p < 0.01). Success rate was highest in the talc group of patients who needed no re-sclerotherapy procedures.Conclusion: Purified mineral talc was shown to be potentially the best sclerosant for the sclerotherapy of hydroceles and epididymal cysts. This revised version was published online in August 2006 with corrections to the Cover Date.     

Sclerotherapy for hydroceles and epididymal cysts with ethanolamine oleate

Seventeen patients with hydroceles or epididymal cysts were treated by tapping and injection with ethanolamine oleate. All 11 patients with hydroceles were cured. Three of six patients with epididymal cysts were cured. There were no cases of haematoma or infection. Sclerotherapy is recommended as primary treatment for all men over 50 years with hydroceles and for selected cases with epididymal cysts.     

Phenol sclerotherapy for hydrocele: a study in 55 patients

Sclerotherapy with 2.5% phenol solution was used to treat 63 hydroceles in 55 patients with a mean age of 69 years. In 51.6% of the patients (32 hydroceles) 1 treatment was sufficient, while 2 treatments were necessary in 25.8% (16 hydroceles), 3 in 13% (8 hydroceles) and 4 in 8% (5 hydroceles). One patient required 7 injections. Treatment was unsuccessful in 1 patient in whom a local allergic reaction developed. Only 1 patient complained of pain, and other complications were rare and mild. On the basis of this experience we concluded that sclerotherapy with phenol 2.5% is a painless, highly effective, safe and economical procedure that permits one to avoid an operation, anesthesia and hospitalization. Its use is warranted in adults and particularly in the elderly.