scrotal
swelling /enlargement

Hydrocele Repair

Hydroceles are collections of fluid that accumulate in the scrotum around the testicle and can be found in infants, children, and adults. In infants and young children it can involve a hernia resulting from a channel communicating with the abdominal cavity that fails to close after the testicle descends into the scrotum around the time of birth. In older children and adults, it often results from an infection or injury to the scrotum or after prior inguinal surgery such as a hernia repair or varicocele ligation. Hydroceles can resolve spontaneously over time. They can also become uncomfortable and bothersome as they grow in size.

Treatment of hydroceles typically involves surgical removal of the hydrocele sac. This requires a general or spinal anesthesia, takes approximately 30-60 minutes, and is done on an outpatient basis. Surgical correction of hydroceles in infant and young children involves a small incision along the groin with the hernia sac dissected out and repaired while the hydrocele fluid and sac are removed. In teenagers and adults an incision is made along the scrotum. The fluid is removed and the sac is obliterated to avoid recurrent accumulation of fluid. Aspiration is a rarely used treatment for hydroceles. This is a technique in which the fluid is simply removed by placing a needle through the skin with no incision. It can be done under local anesthesia in the office but is associated with a high recurrence rate.

What to expect afterwards:

After surgery it is very common to have swelling of the testicle for several weeks to months. The swelling can be significant depending on the size of the original hydrocele. With larger hydroceles, a drain may be used for several days after surgery to minimize the swelling.  After surgery it is important to use a scrotal support and ice regularly.  One should avoid vigorous exercise and lifting for at least one to two weeks after surgery. Antibiotic ointment should be applied to the scrotal incision twice a day for the first few weeks.

Spermatoceles (Epididymal Cyst)

Spermatoceles and Epididymal cysts are typically painless and completely benign (not cancerous) cysts that form along the epididymis which sits in back of each testicle. They are filled with sperm and usually sit along the top of the testicle and are distinct from the testicle and epididymis. The exact cause of spermatoceles are not known however they are thought to be due to a blockage of a duct along the transportation of sperm causing back pressure and the formation of a cyst. They are commonly seen in men who have had a vasectomy and have been estimated to occur in 25-30% of all men. They can remain stable in size or they can grown. Reasons for getting them removed generally revolve around discomfort associated with their size as they grow.

Surgery involves a general or spinal anesthetic and a small scrotal incision to access the testicle and spermatocele. The procedure usually takes 30-60 minutes and is performed on an outpatient basis. Risks involve recurrence of the Spermatocele which is rare, infection, bleeding and hematoma formation, as well as potential injury to the testicle.

What to expect afterwards:

After surgery it is important to wear a scrotal support and ice to minimize scrotal and testicular swelling. Bacitracin or Neosporin antibiotic ointment should be applied to the incision twice a day for the first few weeks. It is also important to avoid vigorous exercise or heavy lifting for the first one to two weeks after surgery to minimize swelling.

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