Outcomes of hydrocele surgery at surgical camps conducted along the coastal regions of Tanzania.

Abstract

Background:Hydrocele is a known endemic disease, a common chronic manifestation of Lymphatic Filariasis. Hydrocele being endemic in Tanzania especially along its coastal regions causes physical disability and embarrassment in the most productive stage of life, affecting one’s work capacity, social life, married life and frustrations due to inability to perform during sexual intercourse. Hydrocelectomy is the treatment of choice of which partial sac excision technique becoming a technique of choice for most hydroceles especially for huge hydrocele which seem to be commonamong patients at hydrocele surgical camps held along Tanzanian coastal regions. Despite several hydrocelectomies done over the years at these surgical camps, with partial sac excision technique mostly used, a follow up on its outcomes, especially long-term, hasn’t been done. Objective: To assess the outcome of hydrocelectomy on patients who attend hydrocele surgical camps in Tanzania. Methodology: a descriptive cross-sectional study design was used, conducted over a one-year period involving all patients who underwent hydrocelectomy at hydrocele camps conducted along the Tanzanian coastal regions from January 2016 to December 2017. A sample size of 393 was calculated. Data was extracted from the prefilled questionnaires used at the camps and this data was part of the information needed for the questionnaire designed for this study. The remaining information wasbe gathered via telephone interview. A pre-tested and coded Swahili version questionnaire was used with confidentiality adhered, and data was analyzed using the SPSS version 24 program. Ethical clearance was attained from MUHAS research and publication committee. Results: A total of 393 patients were selected, who underwent hydrocelectomyand were called and interviewed, of which 390 responded (response rate of 98.5).The mean age of the respondents was 49.15±13.3 (20 – 101) years. Large sized hydrocele were among the majority, 235 (62.3%), followed by medium sized that accounted for 112 (29.7%) patients. Most patients before surgery had issues with work engagement, being stigmatized and sexual performance as was reported by 343 (87.9%), 323 (82.8%) and 300 (76.9%) patients respectively. Pain and micturition difficulties was reported by a few, in 16 (4.1%) and 7 (1.8%) respectively. Overall complication rate was observed to be 27%, SSI being the leading by 19%, followed by persistent scrotal swelling (7.4%) and scrotal oedema (1.3%). Haematoma formation (0.6%), chronic pain and recurrence (0.5% each) were least reported complications. A statistically significant association was noted between persistence of scrotal swelling and having small to medium sized hydrocele. Also, statistically significant changes in the marital status of the patients who underwent hydrocelectomy was noted before and after the procedure, such that, more patients got married or were cohabiting and less remained single, separated or divorced after hydrocelectomy. Majority of the study participants felt that surgery had brought positive changes in their sex lives, in performing their routine and occupational activities and were satisfied with the appearance of their genitals.They strongly agreed at recommending their peers and relatives suffering from a similar condition to seek for such a treatment. Conclusion: The hydrocele surgical camps are a great contribution towards the fight and elimination of this neglected tropical disease. Some post procedural complications have been highlighted in this study, but these are to a minimal extent. Partial sac excision technique as practiced in our camps is safe, with minimal complications. Any reduction in scrotal size has a positive impact on the patients’ quality of life. Recommendation: Partial sac excision technique of hydrocelectomy to be advocated more among surgeons with patient follow-up to be given more emphasis.