Operating time for idiopathic hydroceles and
epididymal cysts is scarce as these conditions compete with an increasing caseload of more consequential surgical disease.
Therapy is often relegated to repeated aspiration.
Sclerotherapy appears to be effective in a majority of published trials, but comparative effectiveness, efficacy and safety of most agents, including
phenol versus
tetracycline, has not been established A deliberate strategy of re-treatment until cure is not universally practised, with surgery still being offered after single-treatment failures. Two trials, the first consisting of 53 scrotal
cysts treated with 5%
phenol-in-water and the second, 42
cysts treated with
tetracycline, are compared for effectiveness, efficacy and safety of
sclerotherapy per se and of re-treatment. Intention-to-treat analysis yields similar cure rates (no re-accumulation three months after last injection) for
phenol and
tetracycline (83% and 81% respectively, p = 0.8). Per-protocol analysis also yields similar cure rates (100% and 97% respectively, p = 0.26) and mean number of
injections to cure (1.34 and 1.12 respectively, p = 0.069), with range 1-4 and 1-3 respectively. Severe
pain following
tetracycline injection required administration of pre-injection cord block. Other complications occurred equally (25% and 25.7% respectively, p = 0.94) and were trivial except for one case of chronic haematocele treated by
orchiectomy in the
tetracycline group.
Phenol (5%) and
tetracycline are equally efficacious
sclerosants for idiopathic scrotal
cysts, achieving almost 100% cure with re-treatment and matching the efficacy of surgery. Concern about post-treatment fertility applies equally to surgery and demands informed consent for both modalities.