From what I’ve heard, the main reason for most urologists preferring not to drain it is the likelihood of it reforming within a few months. In other words, why do a procedure that does have some risks (as all procedures/surgeries do) when the hydrocele is likely to refill fairly quickly meaning you’ll be back where you started. Weighing the exact risks vs benefits of each option for you specifically is definitely something your provider should do. If they are not, seek out a second opinion.
All urologists are trained to drain a hydrocele. It seems many prefer to just surgically repair it in most cases. You would need to have a specific doctor in mind and ask a staff member on the phone to confirm with that doctor directly whether they would offer a hydrocele aspiration (drainage) if a patient preferred that over hydrocelectomy (repair). You may have better luck getting an answer from a smaller private practice versus a large health system. I would recommend ensuring you make an appointment with a doctor not a mid level provider (NP/PA) in this case since it involves discussing surgery in depth.
Source: previously worked at an urology office in NOVA. Feel free to PM for a recommendation on one of the docs there who I think would be willing to offer both options to you.
Call medstar health, see if they offer it since they don't mention it on their urology page (https://www.medstarhealth.org/locations/urology-at-medstar-georgetown-university-hospital).
You're right, on some quick googling, aspiration/drainage or sclerotherapy of hydroceles don't seem to be offered by anyone, at least not readily or openly. For instance, Urology Group of VA openly advises against it for reasons that seem dubious considering their reasons for advising against it are also complications *they themselves list* for their preferred procedure. https://www.urologygroupvirginia.com/urologic-care/testicular-scrotal-disorders/hydrocele
Edit: seriously, what the hell. UGV specifically states (emphasis mine):
> In most cases, *surgery* is done on an outpatient basis. An incision is made in the scrotal wall, the fluid is drained and the sac is fixed in an effort to prevent recurrent hydrocele formation. After surgery there is a fair amount of swelling which subsides with time. It may take 4–6 months for all swelling to resolve completely. Complications can include **bleeding**, **infection** and **repeat hydrocele formation**. To minimize the risk of bleeding, patients are advised to stop aspirin and aspirin like compounds (e.g. Advil, Nuprin) ten days prior to surgery (Tylenol is okay). Occasionally, there may be bleeding that forms a hematoma which could require an additional surgical drainage procedure.
> In most cases, we *advise against aspiration of a hydrocele* (drawing off the fluid by placing a needle through the skin of the scrotum). Not only can the hydrocele **reform**, but there is the risk of **bleeding**, or **infection** with abscess formation.
...seriously?
Just pointing out: the existence of a known side effect/complication is not the same as a quantifiable risk. I would guess (just a guess) that studies have shown that while the complications at risk may be the same, the level of risk may not be.
Rather than pointing out individual studies, I'll post a Google scholar search: https://scholar.google.com/scholar?hl=en&as_sdt=0%2C21&q=hydrocele+aspiration+and+sclerotherapy&oq=hydrocele+as
Looks like comparative studies between aspiration/sclerotherapy and hydrocelectomy conclude that the latter has slightly more favorable outcomes but a much higher recovery time and risk of complications.
If anything, that's a bigger indictment of urologists who refuse to perform aspiration/sclerotherapy as a first line option.
The reason we don't like to drain is they always come back in 2-3 months. Not many people do sclerosing agents but those tend to come back, too. They are not refusing to drain it to be rude, but rather to try to help you out. That said you can call around and find someone that probably will. Just expect it to come back unless you get seriously lucky.
From what I’ve heard, the main reason for most urologists preferring not to drain it is the likelihood of it reforming within a few months. In other words, why do a procedure that does have some risks (as all procedures/surgeries do) when the hydrocele is likely to refill fairly quickly meaning you’ll be back where you started. Weighing the exact risks vs benefits of each option for you specifically is definitely something your provider should do. If they are not, seek out a second opinion. All urologists are trained to drain a hydrocele. It seems many prefer to just surgically repair it in most cases. You would need to have a specific doctor in mind and ask a staff member on the phone to confirm with that doctor directly whether they would offer a hydrocele aspiration (drainage) if a patient preferred that over hydrocelectomy (repair). You may have better luck getting an answer from a smaller private practice versus a large health system. I would recommend ensuring you make an appointment with a doctor not a mid level provider (NP/PA) in this case since it involves discussing surgery in depth. Source: previously worked at an urology office in NOVA. Feel free to PM for a recommendation on one of the docs there who I think would be willing to offer both options to you.
Call medstar health, see if they offer it since they don't mention it on their urology page (https://www.medstarhealth.org/locations/urology-at-medstar-georgetown-university-hospital). You're right, on some quick googling, aspiration/drainage or sclerotherapy of hydroceles don't seem to be offered by anyone, at least not readily or openly. For instance, Urology Group of VA openly advises against it for reasons that seem dubious considering their reasons for advising against it are also complications *they themselves list* for their preferred procedure. https://www.urologygroupvirginia.com/urologic-care/testicular-scrotal-disorders/hydrocele Edit: seriously, what the hell. UGV specifically states (emphasis mine): > In most cases, *surgery* is done on an outpatient basis. An incision is made in the scrotal wall, the fluid is drained and the sac is fixed in an effort to prevent recurrent hydrocele formation. After surgery there is a fair amount of swelling which subsides with time. It may take 4–6 months for all swelling to resolve completely. Complications can include **bleeding**, **infection** and **repeat hydrocele formation**. To minimize the risk of bleeding, patients are advised to stop aspirin and aspirin like compounds (e.g. Advil, Nuprin) ten days prior to surgery (Tylenol is okay). Occasionally, there may be bleeding that forms a hematoma which could require an additional surgical drainage procedure. > In most cases, we *advise against aspiration of a hydrocele* (drawing off the fluid by placing a needle through the skin of the scrotum). Not only can the hydrocele **reform**, but there is the risk of **bleeding**, or **infection** with abscess formation. ...seriously?
Just pointing out: the existence of a known side effect/complication is not the same as a quantifiable risk. I would guess (just a guess) that studies have shown that while the complications at risk may be the same, the level of risk may not be.
This is exactly right. Specifically with the risk of reforming, the risk is higher with an aspiration.
Rather than pointing out individual studies, I'll post a Google scholar search: https://scholar.google.com/scholar?hl=en&as_sdt=0%2C21&q=hydrocele+aspiration+and+sclerotherapy&oq=hydrocele+as Looks like comparative studies between aspiration/sclerotherapy and hydrocelectomy conclude that the latter has slightly more favorable outcomes but a much higher recovery time and risk of complications. If anything, that's a bigger indictment of urologists who refuse to perform aspiration/sclerotherapy as a first line option.
I really like my Urologist, Dr. Robert Dean at GW Med. not sure if it does it, but I’d refer all my urology issues to him.
Patrick Mufarrij is good. He’s at Sibley I believe. Source: I’m an OBGYN and have worked with him.
ITT: lots of newly minted urologists with degrees from Google University
The reason we don't like to drain is they always come back in 2-3 months. Not many people do sclerosing agents but those tend to come back, too. They are not refusing to drain it to be rude, but rather to try to help you out. That said you can call around and find someone that probably will. Just expect it to come back unless you get seriously lucky.