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Hydrocelectomy for Hydrocele

Typical recovery: Hydrocelectomy is commonly performed as day-care or short-stay surgery. Walking and light routine activity are usually possible within a few days. Swelling and bruising can persist for several days to a few weeks. Return to desk or light work depends on discomfort and occupation, while heavy lifting and strenuous exercise are generally avoided for about four weeks. The operated side can remain somewhat bulkier even after complete healing.

Key points

  • A hydrocele is a collection of fluid around the testicle, not a collection inside the testicle itself.
  • Small, uncomplicated hydroceles that cause little or no bother can usually be observed.
  • Treatment is mainly considered for symptoms, troublesome size, cosmetic concerns or when the swelling interferes with adequate examination.
  • A new adult scrotal swelling should be properly assessed rather than automatically assumed to be a simple hydrocele.
  • Ultrasound is particularly useful when the diagnosis is uncertain or the testicle cannot be felt separately from a large hydrocele.
  • Hydrocelectomy is the usual definitive treatment for a symptomatic adult hydrocele.
  • During hydrocelectomy the fluid is drained and the hydrocele sac itself is modified so that fluid is less likely to reaccumulate.
  • Different operative techniques, including plication or eversion/excision of the sac, can be used depending on the hydrocele and operative findings.
  • Simple needle aspiration removes the fluid temporarily but does not treat the underlying sac and therefore has a high likelihood of recurrence.
  • British Association of Urological Surgeons patient guidance does not recommend simple aspiration as standard definitive treatment because the fluid usually returns quickly and infection can be introduced.
  • Repeated unsupervised needle drainage is not a harmless substitute for assessment and definitive treatment; besides recurrence, needle procedures can cause infection and bleeding or haematoma.
  • Aspiration plus injection of a sclerosant is different from simple aspiration. It is a recognised minimally invasive treatment in selected medically appropriate patients.
  • Evidence comparing aspiration-sclerotherapy with hydrocelectomy suggests less initial procedural morbidity but a substantially higher recurrence rate after aspiration-sclerotherapy.
  • Aspiration-sclerotherapy can therefore be reasonable in selected patients who are at high risk for surgery or strongly wish to avoid an operation after informed counselling.
  • A hydrocele itself is usually benign, but an underlying testicular problem should not be missed when examination is difficult or the presentation is atypical.
  • After hydrocelectomy, swelling and bruising are expected and the operated side may continue to feel bulkier than the opposite testicle even after healing.
  • Recurrence after hydrocelectomy is possible but is substantially less common than after simple needle drainage.

Overview

A hydrocele is a collection of fluid around the testicle within the layers of the tunica vaginalis. In adults it commonly presents as a gradually enlarging, usually painless scrotal swelling. Small hydroceles that cause no significant symptoms often need no treatment. Intervention is considered when the swelling becomes uncomfortable, heavy, cosmetically troublesome, interferes with walking, clothing or daily activity, or when its size prevents satisfactory examination of the testicle. The diagnosis is often clinical, but ultrasound is useful when the diagnosis is uncertain, the testicle cannot be palpated separately from a large swelling, or another scrotal condition needs to be excluded. Hydrocelectomy is the definitive surgical treatment. Through a scrotal incision the fluid is drained and the hydrocele sac is plicated, everted or partly excised depending on its size, thickness and operative findings, so that fluid is much less likely to collect again. Simple needle aspiration alone is not a definitive treatment because the fluid-producing sac remains and the hydrocele usually reaccumulates. Aspiration performed without appropriate assessment can also introduce infection or cause bleeding. Aspiration combined with sclerotherapy is a different, medically recognised technique that may be considered in selected patients who are poor surgical candidates or strongly wish to avoid surgery, but recurrence is generally higher than after hydrocelectomy.

Signs & symptoms

  • Gradual enlargement of one side of the scrotum.
  • A painless or minimally uncomfortable scrotal swelling.
  • A feeling of heaviness or dragging in the scrotum.
  • Difficulty walking, exercising or sitting comfortably when the hydrocele becomes large.
  • Difficulty wearing normal clothing or underwear because of the size of the swelling.
  • Cosmetic concern or embarrassment from a large scrotal swelling.
  • Difficulty palpating the testicle because it is surrounded by a large volume of fluid.
  • Occasional aching or discomfort, although significant acute pain is not typical of an uncomplicated hydrocele.
  • A very large hydrocele may cause skin stretching and interfere with normal daily activities.

What the procedure involves

  1. 1

    Confirm that the swelling is consistent with a hydrocele and assess the testicle and other scrotal structures.

  2. 2

    Arrange scrotal ultrasound when the diagnosis is uncertain, the testicle cannot be adequately examined, or another testicular or scrotal condition needs to be excluded.

  3. 3

    Discuss observation versus treatment according to symptoms, size, examination findings, general health and patient preference.

  4. 4

    For hydrocelectomy, anaesthesia is usually general or spinal, although other approaches may be appropriate in selected patients.

  5. 5

    Make a scrotal incision over the affected side and carefully expose the hydrocele sac.

  6. 6

    Open the sac and drain the accumulated fluid.

  7. 7

    Inspect the testicle and surrounding structures when appropriate.

  8. 8

    Treat the hydrocele sac by plication, eversion or partial excision according to its size, thickness and operative findings.

  9. 9

    Preserve the testicle, epididymis, vas deferens and testicular blood supply.

  10. 10

    Secure haemostasis carefully because postoperative scrotal haematoma is an important potential complication.

  11. 11

    Close the wound, usually with absorbable sutures, and provide scrotal support.

  12. 12

    Most uncomplicated hydrocelectomies can be managed as day-care or short-stay procedures.

Preparation

  • Bring any previous scrotal ultrasound reports and images if available.
  • Tell the surgeon how long the swelling has been present and whether it has changed in size.
  • Mention any previous hydrocele aspiration, sclerotherapy or surgery, including how many times the fluid has been drained.
  • Tell the surgeon if there was fever, infection or severe pain after any previous aspiration.
  • Mention previous scrotal trauma, epididymo-orchitis, hernia surgery or other scrotal operations.
  • Tell the treating team if you have only one functioning testicle or any previous fertility problems.
  • Bring a current medication list, particularly anticoagulants and antiplatelet medicines.
  • Do not stop blood-thinning medicines without specific medical instructions.
  • Follow the fasting instructions provided by the anaesthesia and surgical team.
  • Arrange transport home following day-care surgery.
  • Bring supportive underwear or use the scrotal support advised by the surgical team after the procedure.

Recovery and aftercare

  • Expect some scrotal swelling, bruising and discomfort for several days and sometimes a few weeks after surgery.
  • Use prescribed or recommended pain relief as directed.
  • Wear scrotal support or supportive underwear if advised because this often improves comfort.
  • Cold packs wrapped in cloth may help swelling and discomfort during the first few days; do not apply ice directly to the skin.
  • Keep the wound clean and follow the dressing instructions provided at discharge.
  • Absorbable stitches commonly disappear over the following two to three weeks.
  • Walking and light activity are usually encouraged according to comfort.
  • Avoid heavy lifting and strenuous exercise for approximately four weeks or for the period advised by your surgeon.
  • Do not be alarmed if the operated side initially remains bulky; postoperative swelling and the repaired sac can take time to settle.
  • Contact the surgical team if bruising, swelling or pain is becoming progressively worse rather than improving.
  • Seek review for fever, wound discharge, increasing redness or a rapidly enlarging scrotal swelling.
  • A recurrent swelling after apparent recovery should be reassessed rather than repeatedly aspirated without evaluation.

Risks and possible complications

  • Temporary scrotal swelling, bruising and discomfort.
  • A persistent bulky feeling around the operated testicle after repair.
  • Bleeding or formation of a scrotal haematoma.
  • Wound or deeper scrotal infection.
  • Recurrence of the hydrocele.
  • Chronic or persistent scrotal pain.
  • Temporary numbness or altered sensation around the incision.
  • Rare injury to the epididymis or vas deferens.
  • Rare compromise of the blood supply to the testicle.
  • Potential effect on fertility if important reproductive structures are injured, although this is uncommon.
  • Anaesthetic complications.
  • Need for additional treatment if significant bleeding, infection or recurrence develops.

When to arrange prompt medical assessment

  • A newly developed scrotal swelling that has not previously been examined.
  • Progressive enlargement of a known hydrocele that is becoming uncomfortable or interfering with daily activity.
  • A swelling so large that the testicle cannot be felt separately.
  • Development of a new firm area, irregularity or mass within or behind a previously known hydrocele.
  • Persistent aching or heaviness that is affecting activity or quality of life.
  • Redness, increasing tenderness or fever associated with a scrotal swelling, particularly after previous needle aspiration.
  • Rapid reaccumulation after needle drainage of a hydrocele.

When to go to an emergency department now

  • Sudden severe testicular or scrotal pain, especially with nausea or vomiting, because testicular torsion must be excluded urgently.
  • Rapidly increasing painful scrotal swelling following trauma, aspiration or surgery.
  • High fever, marked redness, severe tenderness or systemic illness associated with scrotal swelling.

Myth vs fact

Frequently asked questions

Sources

Medically reviewed by Dr. Shams Alam Mohammed Tahir, MBBS, MS (General Surgery). Last reviewed 2026-09-18.

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