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Practice Variation in the Management of Adult Hydroceles : A Multinational Survey

Practice Variation in the Management of Adult Hydroceles : A Multinational Survey

Title: Practice Variation in the Management of Adult Hydroceles : A Multinational Survey
Author: Forss, Mikko
Bolsunovskyi, Kostiantyn
Lee, Yung
Kilpeläinen, Tuomas P.
Aoki, Yoshitaka
Gudjonsson, Sigurdur
Hervé, François
Järvinen, Petrus
Malde, Sachin
Miyazawa, Katsuhito
... 6 more authors Show all authors
Date: 2023-12
Language: English
Scope: 7
Department: Faculty of Medicine
Surgical Services
Series: European Urology Open Science; 58()
ISSN: 2666-1691
DOI: 10.1016/j.euros.2023.09.005
Subject: Þvagfæraskurðlæknisfræði; Hydrocele; Physicians’ practice patterns; Practice variation; Surgical procedures, operative; Survey; Treatment outcome; Urology
URI: https://hdl.handle.net/20.500.11815/4538

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Forss , M , Bolsunovskyi , K , Lee , Y , Kilpeläinen , T P , Aoki , Y , Gudjonsson , S , Hervé , F , Järvinen , P , Malde , S , Miyazawa , K , Sairanen , J , Sander , L , Violette , P D , Witte , L P W , Guyatt , G H & Tikkinen , K A O 2023 , ' Practice Variation in the Management of Adult Hydroceles : A Multinational Survey ' , European Urology Open Science , vol. 58 , pp. 1-7 . https://doi.org/10.1016/j.euros.2023.09.005


Background: Although hydrocele is one of the most common urologic pathologies, it is seldom studied, and the major urologic associations have no guidelines for the management of adult hydroceles. Objective: To characterize international practice variation in the treatment of adult hydroceles. Design, setting, and participants: An international survey was conducted addressing the management of hydroceles among urologists in Belgium, Denmark, Finland, Iceland, Japan, and the Netherlands from September to December 2020. We invited a random sample of 170 urologists from each country (except Iceland). Outcome measurements and statistical analysis: Urologists’ treatment options, factors relevant for decision-making, expected patient satisfaction, and outcomes after aspiration versus surgery were assessed. Results and limitations: Of the 864 urologists contacted, 437 (51%) participated. Of the respondents, 202 (53%) performed both hydrocelectomies and aspiration, 147 (39%) performed hydrocelectomies only, and 30 (8%) performed aspiration only. In Belgium (83%), the Netherlands (75%), and Denmark (55%), urologists primarily performed hydrocelectomies only, whereas in Finland (84%), Japan (61%), and Iceland (91%), urologists performed both hydrocelectomies and aspiration. Urologists favored hydrocelectomy for large hydroceles (78.8% vs 37.5% for small), younger patients (66.0% for patients <50 yr vs 41.2% for ≥70 yr), patients with few or no comorbidities (62.3% vs 23.1% with multiple comorbidities), and patients without antithrombotic agents (53.5% vs 36.5% with antithrombotic agents). Most urologists considered patient satisfaction to be highest after hydrocelectomy (53.8% vs 9.9% after aspiration) despite believing that hydrocelectomy is more likely to cause complications (hematoma 77.8% vs 8.8% after aspiration). Estimates varied between countries. Conclusions: We found a large variation in the treatment of adult hydroceles within and between countries. Optimization of hydrocele management globally will require future studies. Patient summary: Our international survey shows that treatment of adult hydrocele varies considerably within and between countries.


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