Steroids Do Not Help with Hydrocele Treatment
No, steroids (corticosteroids like prednisone) have no role in the treatment of hydrocele. The provided evidence exclusively addresses infantile hemangiomas (IH) and idiopathic intracranial hypertension—conditions completely unrelated to hydrocele management.
Standard Treatment for Hydrocele
Surgical hydrocelectomy via scrotal incision is the definitive treatment for symptomatic idiopathic hydroceles in adolescents and adults 1.
Primary Treatment Options:
- Open surgical repair remains the gold standard, with two principal techniques: Lord's plication procedure and excision 2
- Surgery is indicated when functional disorders or symptoms are present 2
- The diagnosis is typically clinical, though scrotal ultrasonography is mandatory when the testicle is nonpalpable to exclude underlying testicular masses 1
Alternative Management for Selected Patients:
- Aspiration and sclerotherapy can be considered for patients unfit for general anesthesia or surgery 3, 2
- Sodium tetradecyl sulphate (STDS) demonstrates the best cure rates: 76% after single injection, 94% after multiple treatments, with 95% patient satisfaction at 40 months follow-up 3
- OK-432 (Streptococcus pyogenes preparation) shows efficacy with 18 of 20 patients requiring only one treatment, though side effects include 2-3 days of fever and local inflammation 4
- Sclerotherapy has lower complication rates and shorter recovery compared to surgical repair 3
Pathophysiology and Clinical Considerations:
- Hydrocele results from an imbalance between fluid production and reabsorption in the tunica vaginalis 1, 5
- In adolescents, most hydroceles are acquired and idiopathic 1
- A thorough history must rule out size fluctuation, which indicates patent processus vaginalis 1
- Post-varicocelectomy hydroceles should initially be managed with observation with or without aspiration; persistent large hydroceles require open hydrocelectomy 1
Common Pitfall: Do not confuse hydrocele with conditions that respond to corticosteroids. Steroids have no mechanism of action relevant to the fluid imbalance causing hydrocele and are not part of any evidence-based treatment algorithm for this condition 1, 5, 3, 2.