A hydrocele is an abnormal collection of fluid around the testicle in the scrotal bag.
This may happen because the channel through which the testes descend when the foetus is in the womb never fully closed, or because it reopens. It can also happen due to inflammation or injury of the scrotum or along the channel.
In most case, the only symptom is a swollen scrotum. The increase of size of the scrotum might be slow or rapid onset. Some patients may experience pain or discomfort on crossing the legs, and unsightliness. A few patients complain of mechanical difficulty during sex.
Hydroceles are most common in babies, but they can occur in boys and adult men of any age. There is no set pattern in who is affected.
Diagnosis is by physical examination of the scrotum and, often, by shining a light through. If fluid is collected, the scrotum will allow light through but it will be difficult to feel for the testicle. Sometimes your doctor will send you for an ultrasound scan to check for hernias, tumours and other causes of scrotal swelling.
Hydroceles can be treated by conservative management or operative intervention. Hydroceles in adults typically go away after six months. However, intervention may be recommended if the sac surrounding the testicle hasn’t closed in early development, leading to the risk of a hernia. An operation is the only definitive way to get rid of the scrotal swelling and the fluid, and relieve the discomfort of a hydrocele.
Before surgery, you will typically attend a pre-operative assessment clinic, where your general fitness will be assessed, you will be weighed and your blood pressure taken, and you may have additional tests. You should bring a pair of tight-fitting underwear to wear for support after the operation, to reduce the chance of post-operative swelling and bruising. You will be asked not to eat or drink for about six hours before surgery and just before the operation you may be given a pre-medication by the anaesthetist. On the day of the operation, you will meet the urology team including the surgeon who is carrying out the operation. The surgeon will talk through the procedure and ask you to sign a consent form.
The operation is performed under a general anaesthetic or epidural. The procedure involves making a small incision through the scrotum. The surgeon opens up the fluid-containing sac and drains the fluid, after which the sac is turned inside out and stitched behind the testicle. If it isn’t turned inside out, the fluid will accumulate again because nothing has been done to stop it collecting. Occasionally the surgeon will remove the sac completely.
Hydrocele repair is performed as a day case procedure so you should normally be able to go home the same day. The stitches used are absorbable and do not require removal.
Following the operation, a member of the urology team will come and see you, to tell you how the operation went and what you should expect afterwards. You will be given a discharge summary containing details about your admission and operation, which you should take with you to further consultations. Follow-up is normally with your GP.
After 24 hours, you can remove any dressings and give your groin area a quick wash. Sometimes, instead of a dressing a plastic film is used. Do not remove this – it will flake off when healing has occurred.
You are recommended to avoid long washes until the wound heals. Bathing can lead to stitches dissolving too early, which can cause infection, so you should avoid bathing for a week afterwards. Continue to wear tight supportive underwear day and night for a fortnight after the operation.
Aspiration of the fluid (via a needle and syringe) is performed in elderly and sick patients. But there is increasing scepticism about this approach because fluid collection tends to reoccur afterwards, and because of the risk of infection.
As with any procedure, there are potential side effects from hydrocele repair. A lumpy area above or behind the testicle is common after the operation.
Other common side effects include swelling of the scrotum, lasting for several days and yellow fluid seeping from the scrotum a few days after the operation.
Less often, blood may collect around the testicles, which normally resolves itself slowly but may require surgical drainage. There may be bleeding, and the incision in the scrotum or the testicle itself may become infected, requiring antibiotic treatment or surgical drainage.
In rare cases, fluid surrounding the testicle may start accumulating again, and there is the risk of experiencing chronic testicular or scrotal pain.
Usually, recovery from hydrocele repair takes five days. You should take a week or two off work, and avoid strenuous exercise, lifting heavy objects and sex for a fortnight or until any discomfort has gone. Typically, surgeons will advise scrotal support for two weeks after the operation.