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A hydrocele is a collection of fluid surrounding the testicle. It is located within the outer layer of the testicle called the tunica vaginalis. Hydroceles can also develop due to inflammation or injury within the scrotum. These sometimes resolve over a few months but many remain and require medical attention. While hydroceles may appear alarming, they are benign and non-cancerous. It is important, however, to see a doctor if you notice any abnormality or enlargement of the testicle.
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.
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.
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.
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.
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.