Hydrocelectomy: All you need to know

Hydrocelectomy is a kind of surgery used to remove fluid-filled sacs called hydroceles. These form in the scrotum, the muscular pouch of skin that holds and protects the testicles.

 

A hydrocele forms when fluid from the abdomen flows into the scrotum. A hydrocele causes swelling but is usually not painful. Some people describe it as feeling a little like a water balloon.

Roughly 1 out of every 10 boys is born with a hydrocele, according to the doctors. 

Studies indicate that the condition resolves itself by the time the majority of these boys are 2 years old.

Fast facts on hydroceles Here are some key points about hydroceles. More detail and supporting information is in the main article.
Hydroceles can also develop in adult males, often following an injury that causes swelling.
A physical exam is the first step in diagnosing a hydrocele.
Hydrocelectomy is usually considered minor surgery and performed on an outpatient basis.
Without a hydrocelectomy or other forms of treatment, hydroceles may continue to swell, though most resolve on their own.
In children, a hydrocele is treated mainly to prevent a hernia from developing.

What are hydroceles?

Hydroceles are sacs of fluid that form around the testes. Hydrocelectomy is a surgical procedure to treat them.

Hydroceles can be either communicating or non-communicating.

Communicating hydroceles
In a communicating hydrocele, there is a direct path between the abdomen and the scrotum. Also, an inguinal hernia, where part of the small intestine drops into the scrotum, may be present.

A communicating hydrocele may change its size during a day, growing larger as fluid drains into the scrotum from the abdomen.

Non-communicating hydroceles
In a non-communicating hydrocele, the fluid stays inside the sac but is not absorbed by the body.
Hydrocele of the cord is a particular kind of non-communicating hydrocele, where the condition develops further up in the scrotum. This type of hydrocele may sometimes be confused with an inguinal hernia,cyst, tumour or other problem with the groin area.

Hydroceles in children
For infants with congenital hydroceles, the condition develops between the 28th and 32 weeks of pregnancy, when a muscle in the scrotum opens to let the testes drop.

In some cases, the muscle stays open longer than is needed, doesn't close properly, or opens again, allowing fluid from the belly to flow into the scrotum and form a hydrocele.

Premature birth, cystic fibrosis, and other conditions may increase the likelihood of problems with closure of this muscle.

Hydroceles in adults
In adults, hydroceles affect about 1%  of men over 40 years. Radiation treatment for prostate cancer may increase the risk of developing a hydrocele.

When non-communicating hydroceles develop in adult men, the cause is usually unknown. A hydrocele itself does not cause pain, but men may experience discomfort due to the size and weight of the swollen scrotum.

Even in adults, the condition may disappear on its own in a few months, but if it does not, medical attention is needed and a person should consider having a hydrocelectomy.

Hydrocele diagnosis

Upon examination, a doctor will attempt to feel the condition of the testicle. Ordinarily, this is not possible, due to the surrounding sac of the hydrocele.

Before performing a hydrocelectomy, a doctor may carry out a procedure called transillumination, which involves:
Shining a light through the scrotum, looking for fluid, which would indicate the presence of a hydrocele.
Conducting an ultrasound examination to determine whether the observed swelling is a hydrocele.
Treating the hydrocele with aspiration, using a needle to drain fluid out of the scrotum.

After a positive diagnosis, a doctor may recommend a hydrocelectomy.

What is the procedure for hydrocelectomy?

There are different steps involved in a hydrocelectomy. The procedure used will depend on the type of hydroceles being treated.

The procedure takes place under a general anesthetic. If an infant has a hydrocele that does not go away on its own, surgeons will wait until the child is at least 1 to 2 years old before operating.
The steps involved with a hydrocelectomy depend on whether the hydrocele is communicating or non-communicating: 

Non-communicating hydrocele: Surgeons make an incision in the scrotum, remove the sac, drain the fluid, and close the incision. 

Communicating hydrocele: Treatment is slightly more complicated; doctors make an incision through the groin so that they can treat a hernia, if present, at the same time as removing the hydroceles. Even if there is no hernia, doctors take this approach to prevent a hernia from developing in the future.

Laparoscopic hydrocelectomy

Some surgeons will conduct a hydrocelectomy through laparoscopic (keyhole) surgery, inserting a tube equipped with a camera through the abdomen.

In some cases, individuals and their doctors opt for draining the hydroceles, which can be effective. However, this procedure carries a greater risk of the hydroceles returning.

Procedure

A hydrocelectomy requires a general anesthetic, and most people go home a few hours after having the operation. So, it is important to talk to the surgeon about what to expect for themselves or a child during recovery. It is a good idea to find out what, if anything, merits a call to the doctor.

For the first week or so after the procedure, most individuals will experience pain that requires medication. In addition to pain relievers, using an ice pack on the affected area can also help.

Some individuals may need to use special bandages or a drainage tube during their recovery process.
For a few weeks after surgery, swelling may continue. Activity should be limited, depending on the individual's age and the extent of the procedures performed.

Give children sponge baths, rather than a soak in the tub, for around 10 days after a hydrocelectomy.
For about 3 weeks after the procedure, children should not play with rocking horses, ride bicycles and other straddle toys, or take part in sports.

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