What is a hydrocele (water hernia)?
A hydrocele is a condition in which clear fluid accumulates between the layers of the membrane that wraps the testicle (tunica vaginalis), causing the scrotum on one or both sides to grow with swelling and become tense. The swelling is most often painless, soft and even, and the size can vary — from a slightly enlarged scrotum to a pronounced swelling that interferes with walking, sitting and wearing clothes.
A hydrocele can be congenital (in newborns and small children, when the channel between the abdomen and the scrotum is not fully closed) or acquired (in adults). In adults it most often arises from an imbalance between the production and absorption of fluid in the membrane, and is sometimes a consequence of inflammation, injury, an earlier operation in that area or, more rarely, other conditions of the testicle.
Unlike a true (inguinal) hernia, a hydrocele does not contain intestine but fluid, so it is not dangerous the way an incarcerated hernia can be. Still, when it grows and is bothersome, a hydrocele should be assessed and resolved — above all because a more pronounced swelling interferes with everyday life, and also because it is important to confirm with certainty that no other change lies behind the scrotal swelling.
At Medical Time the hydrocele is first accurately diagnosed by examination and ultrasound, which confirms the nature of the swelling and rules out other changes. Only after that, if surgery is indicated, a procedure is planned that resolves the water hernia permanently, with minimal discomfort for the patient.
When is hydrocele surgery indicated?
A smaller hydrocele that does not grow and causes no symptoms in adults is sometimes simply monitored. However, when the swelling grows, is bothersome or causes discomfort, surgery is the most reliable and lasting way to resolve the problem. The decision is made by the surgeon after an examination and ultrasound.
Hydrocele surgery is recommended in the following situations:
- scrotal swelling that grows or has already become large and tense
- a feeling of heaviness, pressure or discomfort in the scrotal area
- problems with walking, sitting, physical activity or wearing clothes
- an aesthetic problem and psychological discomfort due to the enlarged scrotum
- a hydrocele that returns after a previous aspiration (drawing off the fluid with a needle)
- the need to confirm with certainty the nature of the swelling and rule out other changes
- a hydrocele that accompanies other procedures in that area and is resolved at the same time
How hydrocele surgery is performed
Hydrocele surgery (hydrocelectomy) is a routine procedure whose goal is to remove the accumulated fluid and permanently prevent it from re-forming. This is achieved by treating the membrane around the testicle, not just by drawing off the fluid — which is exactly why surgery is more reliable than a simple needle aspiration, after which the fluid almost always accumulates again.
Through a small incision on the scrotum (or, in a congenital hydrocele in children, through an incision in the groin) the surgeon reaches the membrane around the testicle, releases the accumulated fluid and then treats the membrane so that re-formation of fluid is prevented. Most often the technique of everting and suturing the membrane (Jaboulay procedure) or its partial removal is used, depending on the findings and the surgeon's assessment.
This achieves a lasting solution with a very low percentage of recurrence. In children the congenital hydrocele is resolved by closing the channel that connects the abdomen and the scrotum, which removes the cause of the fluid accumulation.
Aspiration (drawing off the fluid with a needle) is not a lasting solution because the fluid almost always accumulates again, and repeated aspiration carries a risk of infection. That is why, when a hydrocele is bothersome, surgery is recommended as a reliable and lasting choice.
Preparation for hydrocele surgery
Preparation begins with an examination and scrotal ultrasound, which confirm the diagnosis and rule out other changes. Since the procedure is most often done under spinal or general anesthesia (and for smaller hydroceles sometimes under local anesthesia), appropriate preoperative preparation is carried out.
Before the operation the anesthesiologist assesses the safest form of anesthesia based on laboratory tests, an ECG and the patient's health status. When the procedure is done under anesthesia, it is important to follow the rules on fasting and to arrange accompaniment for the return home.
What is important to inform the surgeon of before the procedure:
- all medications you take, especially blood thinners
- chronic illnesses, previous operations in the groin and scrotum area and allergies
- an earlier aspiration of a hydrocele or other interventions in that area
- bring earlier findings and a scrotal ultrasound for review
- the rules on fasting before anesthesia and arranged accompaniment
- bring snug underwear or a supporter for the period after the operation
The procedure, anesthesia and duration
Hydrocele surgery is most often performed under spinal or general anesthesia, and for smaller hydroceles local anesthesia is also possible — so the patient feels no pain during the procedure. The form of anesthesia is decided jointly by the surgeon and the anesthesiologist. The whole course takes place in the sterile conditions of the operating room.
After the anesthesia is introduced, the surgeon makes a small incision, releases the accumulated fluid and treats the membrane around the testicle (by everting and suturing or partial removal) to permanently prevent re-accumulation. The bleeding is then stopped, the wound is closed with sutures, a small drain is placed if needed, and finally a sterile dressing.
The procedure itself most often takes between 30 and 60 minutes, depending on the size of the hydrocele and the technique applied. With a procedure under general or spinal anesthesia the anesthesiologist monitors the vital functions throughout the operation, so the procedure is safe and controlled.
After the operation the patient recovers under the supervision of the staff. In the vast majority of cases this is a procedure after which you go home the same day or with a short stay for observation, which the surgeon decides.
Recovery after hydrocele surgery
Recovery after hydrocele surgery is, as a rule, tidy. In the first days mild pain, swelling and bruising in the scrotum area are normal and gradually subside. Wearing snug underwear or a supporter helps relieve the area and reduce swelling, so it is recommended during the first weeks.
Most patients return to lighter activities after a few days, while strenuous physical activities, sport, lifting, cycling and sexual activity are postponed according to the surgeon's instructions — usually a few weeks, until the wound has fully healed. Mild scrotal swelling may last somewhat longer and subsides gradually.
What is recommended during recovery:
- keep the wound clean and dry and dress it according to the instructions
- wear snug underwear or a supporter to relieve the area and reduce swelling
- keep the area elevated and, if needed, cool it in the first days to reduce swelling
- avoid heavy lifting, strenuous sport and cycling until the wound has healed
- postpone sexual activity according to the surgeon's advice
- contact the doctor if increased pain, redness, pus, large swelling or a temperature appear
Risks and possible complications
Hydrocele surgery is a safe and routine procedure, and serious complications are rare. As with any operation, there are general risks related to anesthesia and local risks in the procedure area, of which the patient is informed in advance.
Locally, bleeding and a collection of blood (hematoma) in the scrotum are possible, as well as wound infection, swelling that lasts somewhat longer and transient pain. Rarely, a hydrocele can reappear, as can a collection of fluid in the wound (seroma). Very rarely there may be injury to surrounding structures, which an experienced surgeon avoids with a careful technique.
It is important to know that surgery, unlike needle aspiration, gives a lasting solution with a very low percentage of recurrence. With a proper surgical technique, sterile conditions and following the wound care instructions, most risks are reduced to the lowest level. That is why it is important that the hydrocele is resolved expertly, in a facility that provides safe, hospital conditions.
Why have hydrocele surgery done at Medical Time
At Medical Time we resolve the hydrocele permanently and painlessly, with an experienced surgical team, modern hospital conditions and constant anesthesiologist supervision. Everything — from examination and ultrasound, through the operation, to further monitoring — is available in one place, quickly and discreetly.
We attach special importance to an accurate diagnosis before the procedure and to a reliable, long-lasting result of the operation. After the procedure we remain at your disposal for dressing changes, follow-ups and all advice on care, until you have fully recovered.
- a lasting solution by surgery, with a very low percentage of recurrence
- an accurate diagnosis before the procedure by examination and ultrasound
- a painless procedure under spinal, general or, if needed, local anesthesia
- an experienced surgical team and constant anesthesiologist supervision
- modern, sterile hospital conditions and high safety standards
- fast recovery and, as a rule, a return home the same day
- a discreet approach and monitoring throughout recovery
Price — hydrocele surgery
The price of hydrocele surgery depends on the size of the change, the technique applied, the form of anesthesia and on whether it is done on one or both sides. You get the exact price and an appointment after an examination and ultrasound, by calling or through the contact form.
- Examination and scrotal ultrasound
- Hydrocele surgery (hydrocelectomy)
- Bilateral hydrocele surgery
For an individual estimate and an appointment, call 062-399-888.
Frequently asked questions about hydrocele
A hydrocele is most often a harmless collection of fluid around the testicle and does not contain intestine like a true hernia. Still, when the swelling grows or is bothersome, it should be assessed by examination and ultrasound — to resolve the symptom and confirm with certainty that no other change lies behind the swelling.
In adults a hydrocele that is bothersome is resolved permanently only by surgery. Aspiration (drawing off the fluid with a needle) brings temporary relief, but the fluid almost always accumulates again, and repeated aspiration carries a risk of infection.
During the procedure you feel no pain, because it is done under spinal, general or, for smaller hydroceles, local anesthesia. After the procedure mild pain and swelling are possible in the first days, which are controlled with analgesics recommended by the doctor and gradually subside.
The procedure itself most often takes 30 to 60 minutes. Most patients return to lighter activities after a few days, while strenuous activities and sport are postponed usually a few weeks, until the wound has fully healed.
Surgery gives a lasting solution with a very low percentage of recurrence, because the membrane around the testicle is treated so that re-accumulation of fluid is prevented — unlike needle aspiration, after which the fluid almost always returns.
A hydrocele itself as a rule does not affect fertility. The operation is performed with a careful technique while preserving the testicle and surrounding structures. If you have questions about fertility, you discuss them with the surgeon before the procedure.
In the vast majority of cases this is a procedure after which you go home the same day or with a short stay for observation. The exact course and any stay are decided by the surgeon depending on the procedure and the form of anesthesia.