A hydrocelectomy is a surgical procedure to repair a hydrocele, which is a buildup of fluid around a testicle. Often a hydrocele will resolve itself without treatment. However, as a hydrocele grows larger, it can cause swelling, pain, and discomfort in the scrotum and may need surgical repair. A hydrocelectomy removes the fluid and shrinks the size of the sac formerly containing the fluid.
Hydroceles are very common in male children, particularly newborns. They also occur in about 1 percent of adult men, typically after age 40.
A hydrocele can form in your scrotum but not bother you much or cause any medical problems. You can try taking over-the-counter anti-inflammatory pain relievers and wait to see if the swelling subsides. Often it will go away on its own within six months.
If the hydrocele gets large enough, it may need repair. Symptoms that suggest you may need to consider surgery include:
- swelling on one side of the scrotum
- pain in one or both testicles
- uncomfortable heaviness from enlargement of the scrotum
Before surgery, you’ll have standard preoperative blood and urine tests. A doctor or nurse will explain how the surgery works and whether the surgeon will have to implant a tube to drain fluids for a short time after the surgery. This helps to prevent infection and buildup of fluid in the scrotum after surgery.
Make sure to tell your doctor about all medications and dietary supplements you take, including herbal supplements. Some of these can impair your natural clotting function and cause bleeding. Your doctor also needs to know if you are allergic to any medications or have experienced problems with excessive bleeding.
A few days before the surgery, you should stop taking medications that could affect blood clotting, such as aspirin (Bufferin), warfarin (Coumadin), and clopidogrel (Plavix).
Follow your doctor’s instructions for eating and drinking. It’s likely you’ll be told not to drink or eat at least six hours before the surgery.
Hydrocelectomy is typically an outpatient procedure. It usually requires general anesthesia, which means you’ll be completely unconscious for the surgery. You’ll have a tube inserted in your throat to regulate your breathing.
Before the surgery, you’ll have an intravenous line put in your arm to provide fluids and any medication required.
In a standard hydrocelectomy, the surgeon makes a small incision in the scrotum and uses suction to drain the hydrocele.
The repair can also be done as a minimally invasive procedure using a laparoscope, a tube with a tiny camera at the end. It allows the surgeon to see the inside of the scrotum on an external video monitor. Small instruments can be inserted through the “keyhole” incision to perform the repair.
Complications are extremely rare. Contact your doctor immediately if you notice signs of infection, such as:
- redness or a feeling of warmth at the surgical site
- increasing pain
- bad-smelling fluid seeping from the surgical wound
- increasing swelling
Other possible complications include excessive bleeding, blood clots, damage near the testicle that could affect your fertility, and complications from anesthesia.
Inserting a needle into the hydrocele and withdrawing the fluid (aspiration) is an alternative to surgery. After removing the fluid, the doctor injects a chemical inside the sack (sclerotherapy) around the testicle. This helps prevent fluid from building up again.
In a recent study of 29 men in their early 50s, aspiration and sclerotherapy corrected the hydrocele in 84 percent of cases. But the hydrocele may come back within months, requiring another round of aspiration and sclerotherapy.
Surgery is the most long-lasting repair, with a much lower hydrocele
A hydrocelectomy normally takes around a half-hour. You can usually go home the same day. You’ll need someone to drive you home. The doctor may install a small tube in your scrotum to allow fluids to drain.
Immediately following surgery, you’ll be taken to a recovery room for observation until it’s safe for you to go home. If you had general anesthesia, you may feel sedated and nauseated, and your throat may be sore from the breathing tube.
You’ll schedule a follow-up appointment in a few weeks so your doctor can check for proper healing and possible signs of infection or other complications.
At home, expect swelling and soreness for a few days. During this time, your scrotum will be bandaged. Using a jockstrap to support your scrotum reduces discomfort.
For the first few days, apply cold packs for 10 to 15 minutes at a time to reduce swelling and pain. Learn how to make your own cold compress at home. You can shower if the bandaged area is covered to prevent it from being soaked. Don’t take baths, swim, or sit in a hot tub until the wound heals. Your scrotum may remain swollen for up to a month.
Don’t lift heavy weights and avoid vigorous exercise during your recovery. You’ll be advised not to have sex for up to six weeks. Don’t drive while you’re taking sedating pain medications.
Hydrocelectomy is usually successful, and major complications are very rare. Another hydrocele can form after surgery, requiring additional treatment, but this isn’t common. Contact your doctor promptly if you start having swelling and pain in your scrotum again.