From the Research
Surgery is not essential for a 75-year-old man with a right-sided hydrocele unless it causes significant discomfort, pain, or complications. Many hydroceles in elderly men can be managed conservatively through observation if they are small, asymptomatic, or cause minimal discomfort. Conservative management includes periodic monitoring, wearing supportive underwear, and taking over-the-counter pain relievers like acetaminophen or ibuprofen as needed for discomfort.
Key Considerations
- The most recent and highest quality study 1 suggests that aspiration and sclerotherapy can be an effective treatment option for hydroceles, with a cure rate of 76% after a single injection and 94% after multiple treatments.
- However, surgical intervention (typically a hydrocelectomy) should be considered if the hydrocele is large, painful, continues to grow, causes difficulty with walking or daily activities, or if there's concern about underlying testicular pathology.
- The decision should be individualized based on the patient's overall health status, surgical risk factors, and quality of life impact, as noted in 2.
- Age alone is not a contraindication to surgery, but the risks of anesthesia and potential complications must be weighed against the benefits, especially in an elderly patient who may have other medical conditions.
- A urologist should evaluate the hydrocele to rule out more serious conditions like testicular cancer before determining the appropriate management approach.
Management Options
- Aspiration and sclerotherapy: a nonsurgical treatment option with a high success rate, as shown in 3 and 4.
- Hydrocelectomy: a surgical procedure with a high success rate, but associated with higher risks and complications, as noted in 5 and 2.
- Conservative management: observation, periodic monitoring, and supportive care, as appropriate for small, asymptomatic, or minimally symptomatic hydroceles.