Hydrocelectomy refers to a surgical removal of a fluid balloon around the testicle (or in the scrotal sac). It is normal to have a very thin layer of fluid directly surrounding the testicle. This fluid is constantly produced and drained so that it does not accumulate. In an adult, the tissue responsible for draining the fluid becomes blocked and so fluid begins to accumulate and the scrotum enlarges over time.
Hydroceles are most often discovered by a patient. They may not change for years but then suddenly grow larger and more cumbersome. Other than patient discomfort or cosmetic reasons, there is rarely a medical need to operate on a hydrocele. Occasionally, a hydrocele may be associated with an underlying abnormality of the testicle. This may, on very rare occasions include a testicular cancer. For this reason, before any operation to remove a hydrocele is undertaken, an ultrasound of the scrotum is always required.
Please refer to the detailed information provided by the rooms. This is also available on the website. The procedure will not be performed if you are currently taking, or have recently taken any medication that may interfere with your ability to clot your blood (“blood thinners, aspirin, anti-inflammatory medicines, etc…”). The most common of these medications are aspirin and all related pain relievers or anti-inflammatory compounds (whether prescription or over the counter).
It is important that you have a good pair of supportive underwear ready at home. You will need to wear them for a couple of weeks after surgery. Support helps to reduce swelling.
The procedure usually takes less than one hour depending on an individual’s anatomy and whether a prior hydocele or other procedure has been performed in the scrotum. An incision is made in the midline or across the involved side of the scrotum. Dissection is then performed down to the hydrocele sac. The sac is freed from surrounding tissue, opened and drained of its fluid. The sac is then turned inside-out and the edges sewn together or it is completely cut away. The testicle and adjacent structures are inspected to ensure that everything else appears normal.
If your hydrocele is large, we may elect to place a small drainage tube through the scrotal skin to help minimise the swelling. If we do so, we will have you return to the hospital in the next few days to remove the drain.
You will be in the recovery room for a short time before being sent home. You may have discomfort over the incisions and possibly in the groin and scrotum. There may be a scrotal support with some gauze underneath. There may be no dressing directly adherent to the incision and so the stitches may be visible. Sometimes, you will notice a white glue-like substance over the incision.
Occasionally there is small blood staining on the gauze or skin, and this is normal. If the dressing becomes soaked or you see active blood oozing, please return to hospital or contact the rooms. You may shower the day after surgery, but no baths or swimming. We ask that you refrain from any strenuous activity until your follow up. Every patient has some degree of swelling and bruising, and it is not possible to predict in whom this might be minimal or significant.
We strongly encourage you to take the following day off of work and perhaps more if your occupation requires strenuous activity or heavy lifting. In the first 24 hours, it is to your advantage to minimise activity and spend a lot of time lying down. The more swelling you prevent in the first two days, the better off you are. You will be given a prescription for antibiotics and pain relief that should be taken as directed.
Expectations of Outcome
It is important for you to realise that the effects of the procedure can take days, weeks, or even more than a month to be fully apparent. The tissues within the scrotum always swell and usually feel quite firm to the touch after swelling begins. This is expected, and you should not feel as though your surgery was unsuccessful.
Hydroceles very rarely recur because the tissue that caused it is either gone or turned inside out.
Possible Complications of Outcome
The vast majority of patients have no problems after hydrocele excision. However, all surgical procedures, regardless of complexity or time, can be associated with unforeseen problems. They may be immediate or even quite delayed in presentation. We would like you to have a list so that you may ask questions if you are concerned. Aside from anaesthesia complications, it is important that every patient be made aware of all possible outcomes which may include, but are not limited to:
- Blood Loss / Transfusion Recurrence or Persistence
A hydrocele may return. As mentioned, this is fairly unusual with a formal hydrocelectomy but common after a simple need drainage procedure.
This is when a blood vessel continues to ooze or bleed after the procedure is over. The result is greater swelling and bruising. It usually resolves over time with compresses… much like any bad bruising or swelling. If the haematoma is unusually large (cumbersome or painful) or does not show resolution in a reasonable amount of time, a procedure to evacuate the clots may be required.
Infection is possible after any procedure. Usually, local wound care and antibiotics are sufficient. Occasionally, an infection would require partially opening the wound to allow proper drainage.
- Chronic Pain
As with any procedure, a patient can develop chronic pain in an area that has been operated on. Typically, the pain disappears over time. If persistent, further evaluation would be necessary.
- Testicular Ischemia/Loss
This is quite unlikely from the operation itself, but could occur.
Please contact the office within 3 days of discharge. You should make an appointment to see Dr Sved as directed in the hospital. Do not hesitate to call at any time if you have any concerns.