Longstanding hydrocele in adult Black Africans: Is preoperative scrotal ultrasound justified?

Abstract

Background: Longstanding hydrocele is very common among adult Black Africans. Preoperative scrotal ultrasound is widely used for adult patients presenting with hydrocele, with the main aim to rule out more serious underlying pathologies like malignancy or testicular torsion. This paper analyzes the findings and the necessity of automatic ordering of scrotal ultrasound in cases of longstanding hydrocele in adult Black Africans. Materials and Methods: 102 consecutive patients with longstanding scrotal hydrocele were investigated clinically and all patients also had routine preoperative scrotal ultrasound. Results: Overall, none of our patients had any serious underlying pathology associated with their hydrocele. 97% of the patients had simple hydrocele on ultrasound. Hydrocele is more common on the right (P=0.04) and is more bilateral in elderly patients (P=0.0002). Conclusions: Routine preoperative scrotal ultrasound does not seem to be justified in longstanding hydroceles. This is especially important considering the fact that most hydroceles are benign in origin and nature.

Key words: Adult hydrocele, Black Africans, health care cost, testicular pathology, ultrasonography