Hydrocele

What are the symptoms?

• Scrotal swelling
• Usually remains painless but may cause discomfort due to the increased size of the scrotum
• The size of the hydrocele can change throughout the day as well, increasing with standing later in the day.
• Can occur on the left side, right side or both

How are hydroceles treated?

Observation

Small hydroceles that are not bothersome can be observed. We still recommend that you visit with your doctor to get an ultrasound done of the scrotum.

Needle Aspiration

This in-office procedure is done to remove the fluid within the capsule, but does not remove the surrounding capsule itself. We first do a scrotal ultrasound to determine the location of the fluid and testicle. Next, a numbing medication is applied, and a needle is inserted into the scrotum. The fluid is then drained with the needle. Since the surrounding capsule stays in place, there is a 30-40% likelihood that the hydrocele may return.

Surgery

Surgical treatment of a hydrocele involves removal of the entire surrounding capsule with fluid. This is an outpatient procedure, meaning you go home the same day, and is done under general anesthesia in the operating room. To remove the hydrocele, an incision is made in the scrotum. The hydrocele is removed, along with the tissues involved in creating the hydrocele. The small incision of the scrotum is closed with absorbable sutures. If there are complications, such as a hernia, an incision is made in the inguinal (groin) area. This approach allows repair of hernias and other complicating factors at the same time. Surgery is a great option to have a hydrocele treated, though a small percentage (10%) of patients do have recurrence.

Post-operative Instructions

• Nausea is common after receiving general anesthesia. If you are having nausea, start a diet with clear liquids, and slowly increase to regular foods. The nausea should subside within 4-6 hours.
• After the surgery, we will prescribe you an antibiotic and a pain medication that you can pick up from the pharmacy.
• It is normal to have pain after surgery which should improve day by day.
• The sutures or stitches will remain in place since they are absorbable, and will dissolve in about 14 days.
• You can remove the gauze dressing the next day. It is not necessary to replace the dressing unless it is comfortable for you.
• You can shower 24 hours after surgery. Refrain from bathtubs, hot tubs, or swimming pools for at least 1-2 weeks.
• Swelling and bruising of the scrotum are normal and temporary. These symptoms will decrease week by week, and should resolve completely within 1-2 months.
• Wear scrotal support for about 4 weeks after surgery. This includes boxer briefs, compression shorts, biking shorts, or jockstrap. The support prevents excess swelling and bruising from occurring.
• Refrain from intercourse and strenuous physical activity for 2 weeks. This includes heavy-lifting, weight-lifting, and exercise. You can walk and use stairs. Use compression shorts with physical activity.
• Your follow-up appointment will be one month after the hydrocelectomy. We will contact you to schedule or you can schedule the appointment ahead of time.
• Please notify us immediately if you have fever (>100.4), chills, or notice excessive drainage/bleeding from the incision site.
• You will have some scar tissue that remains, which make the scrotal skin feel thickened or hardened. This will decrease after the surgery, however, does not completely resolve for some patients.

Recurrence rate

Hydroceles treated with surgery have a lower recurrence rate than those treated with needle aspiration. With needle aspiration, the risk of recurrence is about 50% versus about 10-20% with surgical removal. You may notice the same amount of swelling as before treatment.

Can I get a hydrocele on the opposite side as well?

The risk of developing a hydrocele on the other side is low, about 5%. This can be increased though with infection, inflammation, or trauma or the scrotum or testicle.