Operation for hydroceles

An accumulation of fluids in the scrotum is known as a hydrocele. This must be distinguished from a fluid-filled blister in the area of the epididymis, known as a spermatocele. Both conditions are often perceived as disturbing and may cause discomfort. Surgical treatment is possible via a small incision in the scrotum.

Questions on the diagnosis and treatment of a hydrocele

A hydrocele is an accumulation of fluid between the inner and outer testicle sheath. In the foetus, the testicles initially develop in the abdomen and move into the scrotum by the end of pregnancy. If this connecting channel does not close, abdominal fluid can accumulate in the scrotum. This condition is known as congruential hydrocele (hydrocele with open processus vaginalis testis). Inflammation or violence to the testicle can also result in hydroceles that are not congenital. Very rarely, testicular tumours can cause an accumulation of fluid as well.

A hydrocele is typically noticed due to a slow increase in swelling of the scrotum. It can be perceived as disturbing if the hydrocele is very large. There is usually no pain. However, patients often describe a feeling of pulling or pressure in this area. A hydrocele can also occur on both sides of the testicles.

A hydrocele is not dangerous. However, a urologist must rule out other, possibly serious causes of swelling. An experienced urologist often suspects a hydrocele through visual diagnosis, then confirms it through an ultrasound examination.

A hydrocele does not always need to be treated. However, surgical treatment may be recommended based on the size of the hydrocele and any associated pain. Treatment is recommended at the very latest when the hydrocele interferes with the patient’s everyday life. There is no clear limit on what size the hydrocele must be before surgery can be performed.

A simple ultrasound check confirms the diagnosis. It is important to check whether there is a connection to the abdominal cavity, especially in young patients.

An occasional complication is post-operative bleeding, which may require another operation to stop the bleeding. Other risks such as wound infections or testicular injuries are rare.

Brief information on hydrocele surgery

Indication Disturbing/painful enlargement of the scrotum
Procedure Removal of the fluid-forming tissue layers
Surgery time Approx. 45 minutes
Clinic stay 1-2 nights
Note General anaesthesia or spinal anaesthesia

Questions on hydrocele surgery

Various procedures are available to remove the hydrocele. In order to avoid recurrence as much as possible, a certain procedure is recommended. The testicle and epididymis are removed from the scrotum through an incision, together with the sheaths between which the hydrocele is located. The sheaths are then carefully removed, maintaining distance from the testicle and epididymis, and the testicle is placed back in the scrotum. The wound is then sutured.

In case of a congenital hydrocele connected to the abdominal cavity, the procedure is performed from the groin. Similar to an inguinal hernia surgery, the connecting channel to the testicle is then closed.

A principle treatment alternative to surgery for hydroceles is puncture, if necessary in combination with sclerotherapy. However, the hydrocele usually recurs. The procedure is also associated with risks such as bleeding or infection. If an infection occurs after puncturing the hydrocele, a later hydrocele surgery can be more difficult. An experienced urologist chooses the best course of treatment for the specific patient.

Admission for the procedure takes place on the day of the surgery. After the operation, inpatient treatment is recommended for 1-2 days. During this time, the testicle should be elevated and cooled. It is recommended not to work for 1 week after being discharged and avoid physical exertion.

The chances of success of the procedure are very good. In the first period after the operation noticeable swelling is often present, which disappears completely within a few weeks. Only in very rare cases does the hydrocele reappear.

About this page:


Prof. Dr. med. Sven Lahme
Urology specialist

Medical director of the Goldstadt-Privatklinik.
Specialist for Urology, Mini-PCNL and robot-assisted da Vinci procedures.

Member in Scientific Societies and Reviewer of scientific journals.

Creation Date: 08.03.2020Modification date: 08.03.2020