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Hydrocelectomy

Last updated May 7, 2018

Approved by: Krish Tangella MD, MBA, FCAP

ResoluteSupportMedia

A young boy is being prepared to go under anesthesia prior to undergoing a hydrocelectomy.


Background Information:

What are the other Names for the Procedure?

  • Hydrocele Repair

What is Hydrocelectomy surgical procedure?

  • Hydrocelectomy is a surgical procedure that involves removing or repairing the hydrocele
  • Hydrocele is a condition in which fluid accumulates around the testicle, resulting in swelling of the scrotum
  • The fluid accumulates, either due to a defective absorption, or irritation of the membrane covering the testicle (tunica vaginalis)
  • During development in the mother’s uterus, all babies form a tunnel through the abdominal wall
  • In male babies, the tunnel connects the abdominal cavity with the scrotum; in female babies, this tunnel connects the abdominal cavity with the labia
  • The tunnel has a thin lining called the "processus vaginalis". This lining is nothing but, an extension of the same layer that lines the inside of the abdominal cavity. The tunnel and its lining, normally seal-off prior to birth
  • Sometimes, when it seals-off, some fluid is trapped around the testicles in the scrotum. This is called a non-communicating hydrocele
  • Sometimes, the tunnel does not completely close down. As a result, at times, the fluid can drip down and accumulate in the scrotum, to cause it to look bigger. At other times, it can drain back into the abdominal cavity, thus making the scrotum look normal in size. This is called a communicating hydrocele

What part of the Body does the Procedure involve?

A Hydrocelectomy procedure involves the scrotum, spermatic cord, membrane covering the testicle (tunica vaginalis), and the surrounding nerve and blood vessels connected to the scrotum.

Why is the Hydrocelectomy surgical procedure Performed?

Hydrocelectomy is performed for the following reasons:

  • Repairing congenital inguinal hernia, which is usually associated with congenital hydrocele (in infants)
  • Removal of painful and visually unattractive scrotal swelling

What are some Alternative Choices for the Procedure?

  • In infants, surgery may not be needed (in some cases) and the hydrocele (especially the communicating hydrocele) may get better with time. A ‘wait and watch’ approach may be used by the healthcare provider, in such cases
  • If hydrocele is too large or becomes infected, Hydrocelectomy remains the gold standard approach

What are the Recent Advances in the Procedure?

Laparoscopic repair is a recent advancement with respect to the procedure. 

What is the Cost of performing the Hydrocelectomy surgical procedure?

The cost of Hydrocelectomy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Hydrocelectomy procedure and what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
  • Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006

http://health.yahoo.net/galecontent/hydrocelectomy-1

http://www.allkids.org/body.cfm?id=1047

Prior to Hydrocelectomy surgical procedure:

How is the Hydrocelectomy surgical procedure Performed?

The approach to the procedure is different in babies, when compared to adults.

In babies:

  • For infants with a non-communicating hydrocele, the surgeon may decide to observe the condition, for a year or so, as in most of the cases, a surgery may not be needed and the swelling reduces gradually
  • For those with a communicating hydrocele, or a non-communicating hydrocele that might not get better, a surgery is performed through the groin
  • The surgeon makes a cut in the groin and the cut is carried down through the different layers of the abdominal wall
  • The hydrocele sac is identified and the fluid is drained. The sac may be removed and the communication with the abdominal cavity closed with stitches
  • The surgeon may sometimes perform a concurrent hernia repair, by strengthening the muscle wall with stitches
  • Sometimes, the surgeon uses a laparoscope to perform this procedure
  • Laparoscopic hernia repair is a procedure wherein a tiny camera is inserted into the area through a small surgical cut. The camera is attached to a video monitor
  • The surgeon performs the repair with instruments that are inserted through other small skin cuts

In adults:

  • A surgical cut is made on the skin of the scrotum. The incision is then carried down through different scrotal layers till the sac is encountered
  • The sac is separated from the testicle and removed. The fluid may sometimes be drained, prior to removal of the sac
  • The scrotum is closed in layers

Where is the Procedure Performed?

A Hydrocelectomy procedure is usually performed in an out-patient surgery center facility or a hospital. Normally, the individual can go home, once the procedure is completed.

Who Performs the Procedure?

A general surgeon, a pediatric surgeon, or an urologist performs a Hydrocele Repair procedure.

How long will the Procedure take?

It usually takes less than an hour, to complete the procedure.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

  • Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
  • If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
  • If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)

A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are being currently taken
  • Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
  • Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
  • Do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
  • Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
  • It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
  • Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
  • The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
  • For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for a Hydrocelectomy procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Hydrocelectomy surgical procedure?

Before Hydrocelectomy procedure, the patient has to undergo certain tests such as:

  • Routine blood and urine analysis
  • Ultrasound imaging

What are some Alternative Choices for the Procedure?

  • In infants, surgery may not be needed (in some cases) and the hydrocele (especially the communicating hydrocele) may get better with time. A ‘wait and watch’ approach may be used by the healthcare provider, in such cases
  • If hydrocele is too large or becomes infected, Hydrocelectomy remains the gold standard approach

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

  • What is a Hydrocelectomy surgical procedure?
  • Why is this procedure necessary?  How will it help?
  • How soon should I get it done? Is there an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed? 
  • What are the risks while performing the procedure?
  • What are the complications that might take place, during recovery?
  • How long will it take to recover? When can I resume normal work?
  • How many such procedures have you (the physician) performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • What are the costs involved?

During the Hydrocelectomy surgical procedure:

What kind of Anesthesia is given, during the Procedure?

An injection of local anesthesia, general anesthesia by injection and inhalation, or occasionally spinal anesthesia by injection, is administered for this procedure.

How much Blood will you lose, during the Procedure?

Hydrocelectomy is a less invasive procedure and so the amount of blood loss is generally minimal.

What are the possible Risks and Complications during the Hydrocelectomy surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

  • Obesity: Generally greater the degree of obesity, greater is the surgical risk
  • Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
  • Advancing age
  • Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
  • Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
  • Poorly functioning liver, as evidenced by increased blood liver function tests
  • Hypertension (increased blood pressure), especially if it is poorly controlled
  • Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
  • Poor lung function, as evidenced by abnormal lung function tests
  • History of bleeding disorders
  • Longstanding illness, such as autoimmune disorders, chronic infections
  • Poor immune system due to a variety of causes

The possible risks or complications that may arise during the surgery are:

  • Excessive bleeding
  • Infection surrounding the surgical wound
  • Anesthetic complications
  • Injury to the adjacent structures

What Post-Operative Care is needed at the Healthcare Facility after the Hydrocelectomy surgical procedure?

At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise.

After the Hydrocelectomy surgical procedure:

What are the possible Risks and Complications after the Hydrocelectomy surgical procedure?

Post Hydrocelectomy procedure, the following complications may arise:

  • Excessive bleeding
  • Infection in the surgical wound
  • Loss of bowel/bladder function
  • Decreased supply of blood to the testicle
  • Twisting of the testicle (testicular torsion)
  • Reoccurring hydrocele

What is the Prognosis after the Surgery?

The prognosis is excellent and the success rate is very high, in experienced hands.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

  • Worsening pain and swelling around the surgical wound
  • Bleeding or fluid drainage from the surgical wound
  • The occurrence of any symptom that causes uneasiness, such as nausea and vomiting
  • Signs of an infection
  • Fever
  • Dizziness
  • Feeling sick
  • Muscle aches
  • Headaches
  • Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Hydrocelectomy surgical procedure?

At home, the following post-operative care is recommended, after a Hydrocelectomy procedure:

  • Resume regular/daily activities, as early as possible (under advice by the physician). This aids in a faster recovery
  • Avoid all activities that are physically strenuous for about 6 weeks after surgery
  • A physician advises children and adults to wear proper athletic support attire after the surgical procedure
  • Use a heat pad or warm compress to relieve pain due to the incision
  • Resume showering; however, keep the wound clean and dry. Gently wash the surgical wound with unscented soap and water
  • Replace the dressing on the surgical wound, as advised by your physician
  • Complete the course of prescribed medication, as advised by your physician
  • Take stool softeners to prevent constipation, under advice by the physician
  • Take antibiotic medication to help combat or prevent infection, as directed by your physician
  • Avoid taking nonprescription medications, such as aspirin. However, individuals may take acetaminophen to relieve pain, as necessary
  • Resume driving as advised by your physician
  • Avoid sex till complete healing has taken place (under advise by the physician)

How long does it normally take to fully recover, from the Procedure?

It may take anywhere between 2 to 4 weeks, to recover from this procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

  • The tissue removed is processed in the laboratory under a pathologist's supervision.
  • Slide(s) are prepared once the tissue is processed, and this is examined by a pathologist and a pathology report issued
  • Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Hydrocelectomy surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The outpatient facility or a physician’s office
  • An anesthesiologist (if anesthesia was administered)
  • A pathologist (if the tissue was sent for analysis)
  • A general surgeon, a pediatric surgeon, or urologist

The patient is advised to inquire and confirm the type of billing, before the Hydrocelectomy procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Jan. 6, 2014
Last updated: May 7, 2018