Surgery for hydrocele of the testicle (hydrocelectomy)

A hydrocele is a collection of fluid between the inner and outer coverings of the testicle. In the foetus, the testicle first develops in the abdominal cavity and migrates into the scrotum by the end of pregnancy. If this connecting channel does not close, abdominal fluid can repeatedly accumulate in the scrotum. This is then referred to as a congenital hydrocele (hydrocele with an open processus vaginalis testis). There is also an acquired form of hydrocele, which often develops after inflammatory processes or trauma to the testicle and, in rare cases, also as a result of testicular tumours.

A hydrocele typically becomes noticeable as a slowly increasing swelling of the scrotum, which is perceived as bothersome once it reaches a certain size. As a rule, there is no pain. However, patients often describe a pulling sensation or feeling of pressure in this area. A hydrocele can also occur on both sides.

A hydrocele is not dangerous. However, other, possibly serious causes of testicular swelling must be ruled out by a urologist. The experienced urologist often already suspects a hydrocele on visual inspection. This is easily confirmed by an ultrasound examination.

A hydrocele does not have to be treated in every case. However, depending on the size of the hydrocele and the associated pain, surgical treatment may be advisable. At the latest when the hydrocele impairs the patient's everyday life, treatment is recommended. There is no clear limit as to the size above which surgery should be performed.

A simple ultrasound examination confirms the diagnosis. Particularly in young patients, attention must be paid to whether there is a connection to the abdominal cavity.

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

Various procedures are available for removing the hydrocele. In order to avoid recurrence as far as possible, the following procedure is recommended: through an incision, the testicle and epididymis with the coverings between which the hydrocele is located are removed from the scrotum. The coverings are then removed while maintaining a distance from the testicle and epididymis, and the testicle is placed back in the scrotum. The wound is then sutured.

If there is a congenital hydrocele with a connection to the abdominal cavity, the operation is performed from the groin. Similar to an inguinal hernia operation, the connecting channel to the testicle is then closed.

In principle, an alternative to surgery for a hydrocele is aspiration, possibly in combination with sclerotherapy. As a rule, however, the hydrocele recurs. In addition, this procedure is associated with risks such as bleeding or infection. In the event of inflammation after aspiration of the hydrocele, later hydrocele surgery may be more difficult. The experienced urologist will choose the appropriate treatment for the patient.

Patients are admitted on the day of the operation. After the operation, inpatient treatment for 1–2 days is recommended. During this time, the testicle should be elevated and cooled. You should not work until one week after discharge and should take it easy physically.

The chances of success of the operation are very good. However, there is often still considerable swelling in the initial period after the operation, which then disappears completely within a few weeks. Only in very rare cases does the hydrocele recur.