Hydrocele surgery

The testicles are lubricated by a thin layer of fluid inside the scrotum. Sometimes this fluid builds up in a sac, forming a hydrocele. A hydrocelectomy (hydrocele surgery) is a minor procedure to drain excess fluid from the sac. This is usually an outpatient procedure, so you can go home the same day. 

Although there are other treatment options for a hydrocele, a hydrocelectomy has the lowest chance of recurrence. 

When is a hydrocele operation needed? 

Hydroceles occur in 1% of adults with testicles aged over 40. While the cause isn’t always clear, they can be caused by infection, injury, or inflammation. In some cases, a hydrocele is small, painless and doesn’t interfere with daily life.  

Surgery may be recommended if you experience:

• Growth in size
• Heaviness and discomfort
• Pain
• Swelling 

Although a hydrocele is often harmless, it is important to see your doctor to make sure that you don’t have another type of scrotal mass (a lump or swelling), which will need immediate treatment.  

While a hydrocele can be a sign of testicular cancer, it may also be a sign of spermatocele, a harmless and painless cyst. Other types of scrotal mass include:

• Epididymitis — inflammation of the tube where sperm is matured
• Hematocele — a blood clot in the scrotum, usually caused by injury
• Inguinal hernia — tissue bulges through the abdominal wall
• Orchitis — inflammation of the testicle
• Testicular torsion — twisted spermatic cord
• Varicocele — an enlarged vein in the scrotum 

Your doctor will examine you and may diagnose a hydrocele by shining a light through your scrotum to see if there is clear liquid inside. They might recommend blood and urine tests to check for infection or an ultrasound scan to check for a hernia, tumour or swelling. 

Is hydrocele surgery right for you? 

Hydrocele surgery is often recommended for healthy adults who want to improve their symptoms, comfort, and the appearance of the scrotum. However, a hydrocelectomy may not be needed, as some hydroceles clear up on their own. 

Alternative treatments to hydrocele surgery 

A needle and syringe can be used to drain the hydrocele if you are unable to tolerate general anaesthetic, not well enough for surgery, or if the fluid needs to be collected for testing. A substance called sclerosant is injected to reduce the chance of recurrence, but this doesn’t guarantee that your hydrocele won’t come back. 

In some cases, a hydrocele will resolve on its own in around 6 months. Over-the-counter pain or anti-inflammatory medication can provide some relief.

A hydrocelectomy usually involves a small cut (incision) in the scrotum to drain the fluid around the testicle. If a bilateral hydrocelectomy (both sides) is needed, this is usually possible through a single cut during a single procedure. The cut is then closed with stitches.

Before the procedure 

You’ll need to complete a pre-admission form detailing your medical history, any medication and supplements you take, and how much support you have at home. You may be asked to pause some of your medications before your surgery eg medications that affect blood clotting. 

Optimising your health ahead of your operation will minimise risks and support your recovery. This means quitting smoking, eating healthy, balanced meals, exercising and managing health conditions as well as possible.  

If you are having a general anaesthetic, it’s essential that you fast (stop eating) for the length of time stated in your admissions letter before your surgery. 

You may need to remove hair from your scrotum yourself, or your surgeon may use an electric shaver with a single-use disposable head if necessary. You will be given a hospital gown and disposable underwear to put on. 

Who will be involved? 

Your medical team will include an anaesthetist, a consultant urological surgeon and specially trained nurses. 

How long does a hydrocele surgery take? 

In most cases, the procedure takes around 20 minutes, but can take up to an hour. The length of the operation depends on the complexity. For example, if you have a hernia, it can be treated at the same time as removing the hydrocele. 

Anaesthetic choices 

In most cases, a general anaesthetic is given for a hydrocelectomy. This means you will be asleep. However, sometimes, a local anaesthetic is preferable, where you will be awake, but the area to be operated on will be numbed so you won't feel any pain. 

You can discuss your options with your anaesthetist. 

Pain during and after surgery 

You may experience some pain, swelling or discomfort after hydrocele surgery, but this is usually mild and can be managed with pain relief. 

What happens straight after the procedure? 

You’ll be taken to a recovery room for monitoring while your anaesthetic wears off. 

If you had a large hydrocele, you might have a drain (small silicone tube) to reduce swelling and remove post-operative fluid for a couple of days. 

Your hospital stay  

Usually, you can go home on the same day, but you might need to stay overnight. It’s normal to feel clumsy, forgetful and slow for 24 hours, so you’ll need someone to drive you home.

You need to be able to eat, drink and use the toilet before leaving the hospital, and you must pass urine within 6–12 hours following your operation. 

Recovery time 

The side effects of a general anaesthetic usually wear off after 24 hours, but you might not feel yourself for a few days, and you will likely need to rest for a week or more. 

You should be mostly recovered in 4–6 weeks. 

Wound care 

Your stitches should dissolve in 2–3 weeks. If you’ve had non-dissolvable stitches, you’ll need a follow-up appointment to have them removed. 

It’s okay to shower if the wound is covered to stop it getting wet, but avoid baths, hot tubs and swimming until it’s healed. 

Sexual activity 

You can return to sexual activity when advised by your doctor. This is usually between 2–6 weeks. 

Pain and swelling 

Use a cold pack to ease pain and swelling for the first few days. Over-the-counter or prescribed pain relief medication can help to manage pain in the first week. You may find close-fitting underwear more comfortable for a couple of weeks as it offers more support. 

It’s normal to have bruising and swelling for 4–6 weeks and have occasional aches for up to 6 months. 

Smoking 

Stopping smoking can speed up your recovery and minimise your chance of infection. 

Driving 

Avoid driving until the side effects of your general anaesthetic have worn off, and only resume when you can comfortably perform an emergency stop. 

Time off work 

You might need to take a week or so off work, or a couple of weeks if your work is physically demanding. 

Physical activity 

You can return to light physical activity after 14 days, and more strenuous activities in one month.

Although rare, every operation carries a risk of: 

• Anaesthetic side effects
• Infection
• Hematoma (blood clot)
• Problems with healing
• Bleeding
• DVT (deep vein thrombosis) 

Any scrotal surgery can mean temporary difficulty passing urine, and a catheter may be needed for a couple of days. 

After a hydrocelectomy, a few in 10 people will develop: 

• Bruising around the base of the penis for 2-3 weeks
• Swelling of the scrotum for a few weeks to a few months 

A few in 100 people will develop treatable conditions, including:

• Urinary retention
• Chronic (long-term) pain
• Recurrence of hydrocele 

A few in 1,000 people will experience testicular damage to the nerves or surrounding blood supply, which could cause pain or fertility issues. There is also a rare chance that the testicle could eventually shrink due to an untreated, squeezed spermatic cord. 

Seek medical advice immediately if you experience: 

• Difficulty passing urine
• Severe swelling or redness of the scrotum
• Yellow/white discharge from the wound
• Fever
• Unmanageable pain