Hydrocelectomy surgery: step by step

• Testicular hydrocele is a collection of serous fluid around a testicle and hydrocelectomy is the surgical procedure performed to remove it.
• Hydrocelectomy is the outpatient procedure indicated in most cases of adult testicular hydrocele or hydrocele associated with inguinal hernia.
• Testicular hydrocele should be treated surgically when there is discomfort, it is infected or the patient chooses to have it removed for aesthetic reasons.

The main reason for treating a hydrocele is the discomfort it may cause the patient, its painful inflammation or for aesthetic reasons that the patient wants to solve. The only solution for hydrocele is hydrocelectomy, which consists of the removal of this serous accumulation. With regard to testicular hydrocele and its origin, we can differentiate between two types:

• Congenital hydrocele: you are born with it and it is advisable to wait until the child is a year or a year and a half old, as it usually disappears on its own and no surgical intervention is necessary.
• Acquired or chronic hydrocele: occurs in adult males throughout life. It can occur in one or both testicles, the latter being called bilateral testicular hydrocele. It is solved by surgical intervention.

The main objectives of hydrocelectomy are to solve the symptoms and improve the patient's quality of life, which may have been affected due to the discomfort that the hydrocele can cause. 

Among the benefits that hydrocelectomy will bring to the patient we can mention:

• Elimination of excess fluid accumulated in the patient's scrotum, thus reducing the size of the lump.
• Elimination of the discomfort and swelling that the hydrocele may cause the patient.
• Improvement of the patient's aesthetic appearance.

We will now explain step by step what the operation for acquired or chronic hydrocele consists of:

1. Approximately one hour before the operation, the patient at home should apply a cream to the groyne (previously shaved), more specifically in the area near the scrotum, which will be indicated in consultations prior to the operation by the surgeon or the medical team.
2. Once in the hospital and in the operating theatre, the urological surgeon will administer a series of antibiotics to the patient to reduce the possibility of infection during the operation.
3. The patient is then sedated by the anaesthesiologist, in most cases using spinal anaesthesia.
4. After anaesthetising the patient, the surgeon makes an incision in the scrotum, no more than 3-4 centimetres long. This incision will allow the surgeon to reach the area where the hydrocele is located. In the case of a bilateral testicular hydrocele (in both testicles), the incision will first be made on one side and then on the other.
5. After dissection of all the scrotal layers, the surgeon reaches the tunica vaginalis, where the testicular hydrocele is located.
6. Once the testicular hydrocele is located, the surgeon will proceed to aspirate the fluid accumulated in the hydrocele until the sac decreases in size, so that it can also be removed. The remaining fluid will then be removed.
7. After the removal of the fluid and the sac, the hydrocele problem will be solved and the area will be sutured. Once the surgery is over, the patient will have to stay in a room for approximately one hour.

Hydrocelectomy is a simple operation, lasting between 20 and 60 minutes, depending on the type of testicular hydrocele (bilateral or unilateral) and the size of the sac.

Normally, the patient will leave the hospital after a few hours if the operation is performed in the morning. If the operation is performed in the afternoon or if the surgeon recommends it, the patient may spend the night in hospital.

After the operation and before the patient is discharged from the hospital, the medical team will explain to the patient how to clean the surgical wound and what post-operative care should be followed.

The main instructions to be followed by the patient after hydrocelectomy are as follows:

• Mild painkillers should be taken orally every 6 to 8 hours to control postoperative pain, as prescribed by the specialist.
• To prevent free movement of the scrotal sac, the patient should wear a scrotal jockstrap for the first few weeks.
• The patient should clean the surgical wound regularly to avoid infection and problems with the surgical incision.

As for post-operative visits with the specialist after the hydrocelectomy, this is usually the day after the operation, in addition to the subsequent check-ups indicated by the urologist.