Risk for scrotal surgery after laparoscopic donor nephrectomy: a population-based cohort study

Background — A potential long-term complication of living kidney donation in male donors is scrotal swelling on the same side as the nephrectomy, and some undergo surgery to relieve discomfort from the fluid collection. The long-term risk for this outcome attributable to donation is unknown.

Objective — To evaluate long-term scrotal surgery rates after laparoscopic nephrectomy in male living kidney donors compared with nondonors.

Design — Population-based cohort study (2002 to 2024). (ClinicalTrials.gov: NCT06716723)

Setting — Linked administrative health care databases in Ontario, Canada.

Participants — 898 male living kidney donors who had a laparoscopic nephrectomy were matched in a 1:10 ratio with 8980 male nondonors from the general population. The matching characteristics were age, date of cohort entry, rural residence, income, prior vasectomy, and prior inguinal hernia repair. Participants were followed for a median of 9 years, up to 22 years.

Measurements — The primary outcome was hospitalization for surgery to address a unilateral scrotal fluid collection.

Results — Donors and matched nondonors had a median age of 45 years. The rate of scrotal surgery was higher in donors than nondonors (70 of 898 donors [7.8%] vs. 19 of 8980 nondonors [0.2%]; 8.3 vs. 0.2 events per 1000 person-years; hazard ratio, 38.8 [95% CI, 22.1 to 67.9]; P < 0.001). The median time from donation to scrotal surgery was 5.2 years (IQR, 3.3 to 8.4 years); more than 90% of the surgeries were hydrocelectomies and were performed under general anesthesia. Over 20 years, the cumulative incidence was 13.8% in donors versus 0.7% in nondonors.

Limitation — The precise causal mechanism remains unknown.

Conclusion — Laparoscopic nephrectomy is associated with a higher risk for subsequent scrotal surgery in male living kidney donors.