Hydroceles

A hydrocele is an abnormal collection of fluid around the testicle. It is generally not dangerous and does not need to be treated unless it is symptomatic and causing discomfort. It is unclear why it occurs and sometimes is idiopathic (no clear cause).

Generally no a hydrocele is not dangerous. We often obtain a scrotal ultrasound to ensure there are no testicular masses which would likely warrant evaluation.

Options include observation, needle aspiration (very high recurrence risk), and surgical hydrocelectomy.

Yes, especially if the hernia being operated on is an inguinal hernia, we can remove the hydrocele at the same time.

There are a variety of surgical techniques for removing hydroceles:

• Trans-inguinal approach: useful if done at the time of an open inguinal hernia repair.

• Trans-scrotal approach: most direct approach and useful if done as a single procedure.

Dr. Cober tends to favor doing a trans-inguinal approach at the same time of an open inguinal hernia repair. To keep post-op swelling and complication risks down, he tends to favor a minimal dissection, fenestrating hydrocelectomy.

There are no additional restrictions with lifting or activities. A bulky scrotal support dressing will be kept on for 2 weeks after surgery and can be removed for the bathroom but should otherwise remain in place to minimize swelling.

• A Study on Comparison of Minimal Separation Hydrocelectomy vs. Conventional Hydrocelectomy (Jaboulay’s Procedure)

Excerpt (2024): Hydrocelectomy is considered the gold standard technique for the treatment of hydrocele and the minimally access maneuvers provide the best operative outcomes regarding scrotal edema and hardening and patient’s satisfaction when compared to conventional eversion-excision hydrocelectomies...

A small scrotal incision of about 2cm long was made and incision of the Dartos muscles in the same line was made using with electro cautery. The parietal tunica vaginalis (PTV) was identified grasped and minimal blunt dissection was made by the help of the index finger. A small hole was made for the aspiration of hydrocele fluid. Then a disc of tissue was excised of the parietal tunica vaginalis about double of the skin incision dimension using electrocautery. The edge of the visceral surface of the tunica vaginalis was sutured to the parietal layer of the tunica vaginalis and then to the Dartos muscle and all was sutured to scrotal skin in an everted manner aim to expose the visceral tunica toward scrotal skin. If the visceral surface of the tunica vaginalis is sutured to the Dartos, eversion will be created. Then when this everted structure is sutured to the scrotal skin, it will be in contact the sac with lymph-rich subcutaneous tissues.

• Rowe et al, "The Western snip, stitch, and tug hydrocelectomy: How I do it" https://pubmed.ncbi.nlm.nih.gov/27695592/

• Ziegelmann et al, "Office-based, Minimal-Incision Modified Fenestration Technique for Symptomatic Hydroceles Under Local Anesthesia" https://pubmed.ncbi.nlm.nih.gov/31626858/