A hydrocelectomy is a surgical procedure performed to treat a hydrocele, which is a collection of fluid that accumulates in the thin sheath surrounding the testicle. This fluid-filled sac causes swelling in the scrotum and may lead to discomfort or noticeable enlargement. The procedure involves surgically removing or repairing the hydrocele sac to prevent the fluid from reaccumulating. It is typically performed by a urologist and is often an outpatient procedure, allowing the patient to return home the same day.
Understanding the Condition Requiring Surgery
A hydrocele forms when fluid gathers within the tunica vaginalis, the membrane covering the testicle inside the scrotum. Causes differ between infants and adults. In newborns, hydroceles are frequently congenital, resulting from the incomplete closure of the processus vaginalis, a channel extending from the abdomen. This open channel, known as a communicating hydrocele, allows abdominal fluid to flow into the scrotal sac.
In older children and adults, hydroceles are usually acquired (non-communicating) and result from an imbalance in fluid production and absorption. This type may develop due to localized injury, infection, or inflammation within the scrotum. Common infectious causes include epididymitis or orchitis, which trigger an inflammatory response leading to fluid buildup.
The primary symptom is a painless swelling or enlargement of one or both sides of the scrotum. While typically asymptomatic, a large hydrocele may cause a feeling of heaviness or discomfort, necessitating surgical correction. Diagnosis usually begins with a physical examination, often including transillumination, where a light shone through the scrotum reveals the clear fluid. An ultrasound confirms the diagnosis, rules out other causes of scrotal swelling, and assesses the underlying testicle.
Executing the Hydrocelectomy Procedure
Pre-operative preparation involves fasting, typically starting the night before surgery, to ensure the stomach is empty for anesthesia. The procedure is performed under general or spinal anesthesia. An intravenous line is placed to administer fluids and prophylactic antibiotics to mitigate infection risk.
The surgical technique varies based on the patient’s age and hydrocele type. For adults with a non-communicating hydrocele, the surgeon makes a small incision on the scrotum. The hydrocele sac is exposed, separated from surrounding tissues, and the fluid is drained. To prevent recurrence, the surgeon either excises most of the sac or uses plication, where the sac is turned inside out and stitched to itself.
For infants and young children, whose hydroceles are often communicating, the approach is usually through a small incision in the groin. This allows the surgeon to access and ligate the open processus vaginalis—the channel connecting the scrotum to the abdominal cavity. This step closes the communication, preventing abdominal fluid flow and eliminating the hydrocele. The surgeon closes the incision site with dissolvable sutures or surgical glue.
Managing the Recovery Period
Following the hydrocelectomy, the patient is moved to a recovery room where medical staff monitor their vital signs. Since this is an outpatient surgery, most individuals are discharged home within a few hours once they are stable and able to manage pain. It is common to experience mild pain, swelling, and bruising in the scrotal and groin area immediately after the procedure.
Pain management typically involves prescription medication for the first few days, followed by over-the-counter relievers. Applying a cold pack to the area can help minimize post-operative swelling, which may persist for several weeks. Wearing supportive underwear or a jockstrap is recommended for continuous scrotal support, helping reduce swelling and discomfort during recovery.
The surgical site requires specific care to promote healing and prevent infection. Patients should keep the incision clean and dry. While showering is usually permitted after 24 hours, soaking the wound in a bath, hot tub, or pool must be avoided for at least one to two weeks.
Activity restrictions are necessary; patients should avoid heavy lifting or strenuous exercise for two to four weeks to prevent strain and minimize complications. Patients should contact their healthcare provider immediately if they notice signs of infection, such as a fever above 100.4 degrees Fahrenheit, excessive bleeding, worsening pain, or discharge from the wound site.