A hydrocele is a collection of fluid in certain layers of the scrotum around the testicle. These can be caused by trauma to the scrotum, and subsequent inflammation which leads to water collecting around the testicle. Infection, as well as surgery can also cause these collections. Hydroceles can also be communicating or noncommunicating which means that they can be connected to the abdominal cavity where there is naturally fluid as a reservoir. In a communicating hydrocele, fluid can move between the abdominal cavity and the scrotum, so standing or straining for long periods of time can push additional fluid into the scrotum, which can then drain back to the abdomen when you lie back down at night. In general, noncommunicating hydroceles are more common and can range from very small and clinically insignificant, to much larger collections which can make walking difficult, feel very heavy, lead to a dull achy feeling in the scrotum as well as make your pants not fit anymore. Very occasionally, hydroceles can get infected or build up so much pressure they cause acute pain or testicular dysfunction, but this is quite rare. Hydroceles are generally considered benign, with no malignant potential. Also, hydroceles will slowly increase in size over time.
Reasons for getting hydroceles treated are to treat the symptoms as noted above, or cosmesis. Sucking the fluid out with a needle does not generally work as the lining of the hydrocele sac itself makes the fluid and as such, the fluid will reform once again after the fluid is removed. The surgical procedure for treatment of hydrocele is called hydrocelectomy and is a day (outpatient) procedure. The principle of the operation is removal of the hydrocele sac in its entirety.
You will be admitted to the hospital for day surgery, and brought to the operating room. The Anesthesiologist will administer a general anesthetic and you will be placed in the supine position (laying down, face up). A small incision will be made in the scrotum on the side of the hydrocele. The hydrocele sac will be isolated, preserving the rest of the scrotal contents (testicle, epididymis, vas deferens, blood supply). The Surgeon will make sure there is no element of bowel hernia as part of the issue, and if so, then it will be repaired as well. At this point, the hydrocele sac will be removed and the fluid drained. The surgical site will be verified for hemostasis and the incision closed in layers. A special compression dressing will be applied to the scrotum after the operation, but will likely fall off with the first urination or later in the day. This is okay; keep the incision clean and dry. You will then be recovered in the PACU and discharged home after an hour of observation. Followup visit in the clinic will be scheduled for you between 6 weeks and 3 months postop.
Potential complications of hydrocelectomy include: bleeding, infection, injury to other structures such as the testicle, epididymis, vas deferens, blood supply, scrotal skin, and penis. These risks are low, but not zero and should be considered before undergoing a procedure such as this. There is also the risk that the hydrocele may recur, but this is also of low risk should the operation be conducted in uncomplicated fashion according to the surgical plan.
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