Hydro = water
Cele = balloon-like
Hydrocelectomy refers to surgical removal of a fluid balloon around the testicle (or in the scrotal sac). It is normal to have a very thin layer of fluid directly surrounding the testicle. This fluid is constantly produced and drained so that it does not accumulate. In an adult, the tissue responsible for draining the fluid becomes blocked and so fluid begins to accumulate and the scrotum enlarges over time.
In babies and young children, the cause is usually different. In this instance the hydrocele is usually due to a persistent or previous abnormal communication between the scrotum and the abdominal (peritoneal) cavity that once allowed or continues to allow fluid into the scrotum.
Hydroceles are most often discovered by a patient. They may not change for years but then suddenly grow larger and more cumbersome. Other than patient discomfort or cosmetic reasons, there is rarely a medical need to operate on a hydrocele. Usually the physician can diagnose a hydrocele by physical examination, and sometimes it is confirmed by ultrasound examination. In adolescents or young adults with a new hydrocele, we may suggest an ultrasound because testicular cancer can sometimes present with a hydrocele.
As with any procedure in which anesthesia is administered, you will be asked not to eat or drink anything after midnight on the evening prior to your surgery. You may brush your teeth in the morning but not swallow the water. If you are on medications that must be taken, you will have discussed this with us and/or the anesthesiologist and instructions will have been given to you. The procedure will not be performed if you are currently taking or have recently taken any medication that may interfere with your ability to clot your blood ("blood thinners, aspirin, anti-inflammatory medicines, etc..."). The most common of these medications are aspirin and all related pain relievers or anti-inflammatory compounds (whether prescription or over-the-counter). Please refer to the attached list and tell us if you took any of these within the past ten days. If your new medication is not on the list, alert us immediately so that we may ensure optimal procedure safety. We will have reviewed all of your current medications with you during the pre-operative/pre-procedure consultation. You are obligated to inform us if anything has changed (medication or otherwise) since your previous visit.
We will insist that you have a good quality scrotal support (jock strap) or a good pair of jockey shorts ready at home. You will need to wear them for a couple of weeks after surgery. Support helps to reduce discomfort and swelling.
To review the basics of what we discussed in the office: The procedure takes less than one hour depending on an individual's anatomy and whether a prior hydrocele or other procedure has been performed in the scrotum. An incision is made in the midline or across the involved side of the scrotum. Dissection is then performed down to the hydrocele sac. The sac is freed from surrounding tissue, opened and drained of its fluid. The sac is then turned inside-out and the edges sewn together or it is completely cut away. The testicle and adjacent structures are inspected to ensure that everything else appears normal. We then close the incision.
If your hydrocele is very large, we may elect to place a small drainage tube through the scrotal skin to help minimize the swelling. If we do so, we will have you return to the office in the next day or two to remove the drain.
You will be in the recovery room for a short time before being sent home. You may have discomfort over the incisions and possibly in the groin and scrotum. There may be a scrotal support with some gauze underneath. There may be no dressing directly adherent to the incision and so the stitches may be visible. Sometimes, you will notice a white glue-like substance over the incision. Occasionally there is small blood staining on the gauze or skin, and this is normal. If the dressing becomes soaked, or you see active blood oozing, please contact us. You may shower the day after surgery, but no baths or swimming. Some surgeons may recommend warm baths a couple of times per day a few days after your surgery. We ask that you refrain from any strenuous activity until your follow-up. Every patient has some degree of swelling and bruising, and it is not possible to predict in whom this might be minimal or significant. We may recommend that you apply ice compresses to the scrotum when you return home. We strongly encourage you to take the following day off of work and perhaps more if your occupation requires strenuous activity or heavy lifting. In the first 24 hours, it is to your advantage to minimize activity and spend a lot of time lying down. The more swelling you prevent in the first two days, the better off you are. Some patients have almost no discomfort while others are somewhat uncomfortable for a few days. We may provide you with a prescription for pain medication but you certainly may take an over-the-counter medication to which you are not allergic. Upon your follow-up in the office, we will examine you. The sutures we use are self-dissolving, and therefore just fall out on their own within 2-3 weeks after surgery.
Expectations of Outcome
It is important for you to realize that the effects
of the procedure can take days, weeks, or even more than
a month to be fully realized. The tissues within the
scrotum always swell and usually feel quite firm to
the touch after swelling begins. This is expected, and
you should not feel as though your surgery was unsuccessful.
Hydroceles very rarely recur because the tissue that caused it is either gone or turned inside-out.
Possible Complications of the Procedure
ALL surgical procedures, regardless of complexity or time, can be associated with unforeseen problems. They may be immediate or even quite delayed in presentation.
While we have discussed these and possibly others in your consultation, we would like you to have a list so that you may generate questions if you are still concerned. Aside from anesthesia complications, it is important that every patient be made aware of all possible outcomes which may include, but are not limited to:
- Recurrence or Persistence: A hydrocele may return. As mentioned, this is fairly unusual with a formal hydrocelectomy, but common after a simple needle drainage procedure.
- Hematoma: This is when a small blood vessel continues to ooze or bleed after the procedure is over. The result is greater swelling and bruising. It usually resolves overtime with compresses...much like any bad bruising or swelling. If the hematoma is unusually large (cumbersome or painful) or does not show resolution in a reasonable amount of time, a procedure to evacuate the clots may be required.
- Infection: Infection is possible in any procedure. Usually, local wound care and antibiotics are sufficient. Occasionally, an infection would require partially opening the wound to allow proper drainage.
- Chronic Pain: As with any procedure, a patient can develop chronic pain in an area that has been operated on. Typically, the pain disappears over time. If persistent, further evaluation would be necessary.
- Testicular Ischemia/Loss: This is quite unlikely from the operation itself, but could occur.
We provide this literature for patients and family members. It is intended to be an educational supplement that highlights some of the important points of what we have previously discussed in the office. Alternative treatments, the purpose of the procedure/surgery, and the points in this handout have been covered in our face-to-face consultation(s).
The information contained in this document is intended solely to inform and educate and should not be used as a substitute for medical evaluation, advice, diagnosis or treatment by a physician or other healthcare professional. While Delta Medix endeavors to ensure the reliability of information, such information is subject to change as new health information becomes available. Delta Medix cannot and does not guaranty the accuracy or completeness of the information contained in this document, and assumes no liability for its content or for any errors or omissions. Please call your doctor if you have any questions.
Delta Medix, P.C.