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      As Dr. Birch correctly notes, benign scrotal pathologies are quality-of-life issues rather than life-threatening issues. In addition, the relative impacts of these conditions are a spectrum that will vary greatly between patients. An elderly patient with limited mobility may be unbothered by his large hydrocele, while a young man may be distraught with the same scrotal appearance. The reverse can also be true. With this range of considerations in mind, the decision to undergo surgery must be an informed one. Patients and urologists need to understand the risks and benefits of scrotal surgery, particularly in individuals with multiple risk factors for complications. In this study, we demonstrated that patients with two or more risk factors were over 4 times more likely to experience a postoperative event compared to those with none. Observation or needle decompression (with or without injection of a sclerosing agent) may be better options for these sicker patients.
      • Francis JJ
      • Levine LA.
      Aspiration and sclerotherapy: a nonsurgical treatment option for hydroceles.
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      References

        • Francis JJ
        • Levine LA.
        Aspiration and sclerotherapy: a nonsurgical treatment option for hydroceles.
        J Urol. 2013; 189: 1725-1729
        • American Urological Association
        Stage of the Urology Workforce and Practice in the United States.
        2021 (Accessed July 2022)