Burden of hydrocoele assessed from medical and surgical records in a lymphatic filariasis endemic country, Samoa

Abstract

Background: Samoa is a Pacific Island country that has long been known to have a high burden of lymphatic filariasis. Little has been documented about the burden of disability due to the chronic complications of the disease. We examined the rates of hydrocele amongst the Samoan male population to better understand the situation. Methods: Information on numbers of suspected hydrocele cases in men aged 18years and older from 2006 to 2013 was sought using ICD-10 codes and/or keywords from three sources: the hospital patient information system plus the surgical clinic and operating theater records in Tupua Tamasese Meaole and Malietoa Tanumafili II hospitals in Samoa. Chart review of suspected hydrocele cases was used to confirm the diagnosis of hydrocele amongst suspected cases. The following data items were extracted from patient records where available: date of diagnosis, age, village, hydrocele characteristics (duration, size, and volume), history and cause of injuries, whether lymphatic filariasis was a differential diagnosis, whether ultrasound scan was used to verify diagnosis, and details of any surgery performed. Population data were obtained from the Samoa Bureau of Statistics. Results: There were 535 suspected cases identified from the 3 sources between 2006 and 2013, of which 328 were diagnosed as hydrocele; charts for 56 suspected cases (10.5%) could not be located. The mean age of men with hydrocele was 49.2years. The proportion of men aged ≥18years diagnosed with hydrocele over the study period was 0.62% (328/52,944). North West Upolu had the highest proportion amongst the four regions of Samoa (p<0.001). The proportion of men presenting with hydrocoele increased with age (p<0.001). 14.3% of patients had an injury that could have contributed to the hydrocoele. Only 4.0% of all patient records had lymphatic filariasis recorded as a differential diagnosis. 60.7% of all patients with hydrocele had some form of surgery, with no difference between regions (p= 0.276). The majority of surgeries were hydrocelectomies, where the tunica vaginalis is everted. The mean age of patients that had surgery was 48.2years. It was difficult to estimate hydrocele size and duration due to non-standardized way of reporting. Conclusions: This study used multiple sources to document the number of hydrocoele cases that presented annually to medical facilities in Samoa. This represents a minimum estimate of the burden since some cases may have not presented for treatment. The numbers presenting have fluctuated over the years (2006 to 2013), and improvements in the reporting system are needed. The health system needs to consider ways to address a large number of patients that still require surgery, as well as conducting follow-up of those that did receive surgery. Additionally, clinicians should consider lymphatic filariasis as a differential diagnosis for hydroceles.