Immediate Development of Post-varicocelectomy Hydrocele: A Case Report and Review of the Literature

Abstract and Introduction

Abstract

Introduction Hydrocele development is the most common complication after varicocele repair. The beginning of this kind of hydrocele is variable. The shortest reported onset is one week. In the present report we describe an unusual immediate onset of hydrocele formation following varicocele repair. This represents the first report of a harsh hydrocele onset in the literature.

Case presentation A 29-year-old Caucasian male noticed the development of a big hydrocele just a few hours after inguinal varicocelectomy. The hydrocele remained stable in size throughout 12 years until a hydrocelectomy was done.

Conclusion Mass ligation and division of the spermatic cord structures during varicocele surgery should be avoided. Instead, lymphatic sparing is highly recommended. Differentiation between testicular edema and hydrocele should be confirmed as early as possible to assure the patient properly. This case study highlights the importance of our knowledge about the surgical anatomy of the spermatic cord structures. It definitely advances our understanding of a post-varicocelectomy hydrocele etiology and development. It is an original case report of interest to andrologists, urologists and general surgeons.

Introduction

A hydrocele is an abnormal collection of fluid, usually serous, in the sac of the tunica vaginalis. It represents the most common complication after varicocele surgery.^[1–12] Hydrocele formation following varicocele surgery or a post-varicocelectomy (PV) hydrocele has a lymphatic origin^[5] due to iatrogenic disruption of lymphatics lying in and along the spermatic cord during varicocelectomy.

The onset of a PV hydrocele is an important point which may describe the natural history and pathogenesis of this hydrocele. Although PV hydroceles have been reported in many studies,^[1–12] several of these studies ignored their onset^[12] while others showed a great variability in their timing.^[1–11] Literature review showed that the fastest reported onset of a PV hydrocele was one month in adults^[1] and one week in children.^[2] Herein, we are reporting a case of PV hydrocele with extremely fast onset, highlighting how the surgical procedure originally used had several pitfalls resulting in the immediate development of this hydrocele.

J Med Case Reports. 2014;8(70) © 2014 BioMed Central, Ltd.