Hydrocele Surgery

Introduction

A hydrocele is a collection of fluid that builds up around one or both testicles, causing the scrotum to swell. It is usually painless, but when the swelling becomes large, uncomfortable, or persistent, surgery is often the treatment that gives a lasting result. The operation is called hydrocele surgery, or more formally a hydrocelectomy.

If you or your child has been diagnosed with a hydrocele and surgery has been suggested, you probably have a lot of practical questions. What exactly does the operation involve? Will it be done through the scrotum or somewhere else? How long does it take to recover? Will it affect fertility or sexual function? Is it different for a child than for an adult?

This guide walks through the condition, the reasons surgery is offered, the different surgical approaches used in adults and children, what happens before, during, and after the operation, and what to expect during healing. It is written for adults planning their own surgery and for parents planning care for a child.

What Is a Hydrocele?

The testicles sit inside the scrotum, surrounded by a thin two-layered sac called the tunica vaginalis. Normally, this sac contains only a small amount of lubricating fluid. A hydrocele forms when fluid collects between the two layers of this sac, making the scrotum swell on one or both sides.

Hydroceles fall into two broad categories:

• Communicating hydrocele. A small passage between the abdomen and the scrotum stays open, so abdominal fluid can flow down and collect around the testicle. The swelling often changes size during the day — smaller in the morning, larger by evening. This type is most common in babies and young children.
• Non-communicating hydrocele. The fluid is trapped within the sac and does not connect to the abdomen. The swelling tends to stay roughly the same size, or grows gradually. This type is more common in adults.

Hydroceles can also be classified by cause:

• Primary (idiopathic) hydrocele — the cause is not clear. This is the most common form in adults.
• Secondary hydrocele — the fluid builds up because of another problem in the scrotum, such as infection (epididymitis or orchitis), injury, a testicular tumour, or after surgery in the groin or scrotum.

Most hydroceles are not dangerous in themselves. The reasons for treating them are related to size, discomfort, and ruling out other conditions rather than to immediate medical risk.

Why Hydrocele Surgery Is Performed

Not every hydrocele needs surgery. Many small, painless hydroceles can simply be watched, especially if they are not bothering the patient. In children, most communicating hydroceles close on their own during the first one to two years of life. Surgery becomes the recommended option when one or more of the following apply:

• The swelling is large or heavy. A big hydrocele can pull on the scrotum, make sitting or walking uncomfortable, or interfere with daily activities, exercise, or work.
• It is causing pain or a dragging sensation. Larger hydroceles can ache, particularly at the end of the day.
• It is getting bigger over time. Hydroceles that grow steadily are less likely to settle on their own.
• It is affecting appearance or self-image. Cosmetic concern is a valid reason to seek treatment.
• The skin is becoming irritated or stretched.
• It is interfering with sexual activity, urination, or fitting into clothing.
• It does not close on its own in a child older than one to two years (for communicating hydroceles).
• The diagnosis is uncertain, and the surgeon needs to explore the scrotum to rule out other conditions.

The decision to operate is usually made together with a urologist after an examination and an ultrasound scan to confirm the diagnosis and look at the testicle underneath the fluid.

Alternatives to Surgery

Before recommending surgery, urologists usually consider a few other options. Whether any of these is suitable depends on the patient’s age, the type and size of the hydrocele, and the underlying cause.

Observation (watchful waiting)

For small, painless hydroceles that are not changing the patient’s quality of life, doing nothing is often a reasonable choice. In infants, watchful waiting is the standard approach during the first one to two years because most communicating hydroceles resolve naturally.

Treating the underlying cause

If a hydrocele is secondary to an infection or inflammation, treating that condition — for example, with antibiotics for epididymitis — can allow the fluid to settle without surgery.

Needle aspiration with or without sclerotherapy

In selected adult cases, the fluid can be drained with a needle (aspiration). Aspiration alone is usually a temporary measure because the fluid almost always comes back. To reduce recurrence, the surgeon may inject a sclerosing agent — a substance that irritates the sac lining and helps it stick together. Aspiration with sclerotherapy is sometimes offered to patients who are not fit for surgery or who prefer to avoid an operation. Major urology guidelines generally describe surgery as more reliable for long-term cure, but sclerotherapy remains a recognised alternative in chosen situations.

Aspiration is not used in children because of the risk of injury to nearby structures and the high recurrence rate.

Who Is a Candidate for Hydrocele Surgery?

Most people in reasonable general health can have hydrocele surgery. Before scheduling the operation, the urologist usually reviews:

• The size, type, and duration of the hydrocele
• Ultrasound findings, including the appearance of the testicle
• Any underlying conditions (infection, hernia, possible tumour)
• Past surgeries in the groin or scrotum
• General health, including heart, lung, and bleeding conditions
• Medications, especially blood thinners
• For adults of reproductive age, plans for future fertility

If the ultrasound suggests anything other than a simple hydrocele — for example a possible tumour or a hernia — the surgical plan may change. In men of reproductive age, fertility considerations are discussed because the operation works close to the structures that carry sperm.

Surgical Approaches

Several surgical techniques are used, and the choice depends mainly on age, the type of hydrocele, and the surgeon’s preference and training.

Open scrotal approach (most common in adults)

The surgeon makes a small cut in the scrotum directly over the hydrocele. The sac is drained and then either removed (excised) or turned inside out and stitched behind the testicle (a plication or Jaboulay procedure). Two well-known versions are:

• Jaboulay procedure (eversion). The sac is opened, turned inside out around the testicle, and stitched in place. This is often used for large hydroceles.
• Lord’s procedure (plication). The sac is opened and a series of stitches are placed to gather and shrink it without removing much tissue. This is often chosen for smaller, thin-walled hydroceles and tends to involve less bleeding.

The scrotal approach is usually quick (around 30 to 60 minutes), can be done under spinal or general anaesthesia, and is generally a day-case operation.

Open inguinal (groin) approach

For communicating hydroceles — especially in children — the surgeon makes a small cut in the groin rather than the scrotum. Through this incision, the passage connecting the abdomen and scrotum (the patent processus vaginalis) is found and closed off high up, near where it leaves the abdomen. This is the standard approach for paediatric communicating hydroceles and is similar to the operation done for an inguinal hernia.

The inguinal approach is also used in adults when a hernia is present at the same time, or when the surgeon suspects a problem that cannot be addressed safely through the scrotum.

Mini-incision and minimally invasive techniques

Some urologists use smaller incisions or specially designed instruments to drain and treat the hydrocele sac through a very small opening. These approaches aim to reduce wound size and recovery time. They are generally reserved for selected, smaller hydroceles.

Laparoscopic approach

Laparoscopy — keyhole surgery through the abdomen — is sometimes used in children for communicating hydroceles, especially when both sides are affected, because both internal openings can be closed through the same small incisions. It is not commonly used for routine adult hydroceles.

The right approach is a clinical decision made by the urologist based on the type of hydrocele, age, and other findings. Recurrence rates and complication patterns differ slightly between techniques, and surgeons typically choose the method they have the most experience with and that best matches the anatomy in front of them.

Preparing for Hydrocele Surgery

Once surgery is planned, the urology team will give you specific instructions. The usual steps include:

Pre-operative tests

Most patients have basic blood tests, a urine test, and sometimes an ECG and chest X-ray, depending on age and general health. An ultrasound of the scrotum is usually already on file. If there is any suspicion about the testicle itself, additional tests or blood markers may be checked.

Medication review

Tell the surgical team about all medicines, including herbal supplements. Blood thinners such as aspirin, clopidogrel, or warfarin, and some diabetes medicines, may need to be paused or adjusted before surgery. Do not stop any prescribed medicine without medical advice.

Fasting

You will usually be asked not to eat or drink for several hours before the operation. The exact timing depends on the anaesthetic plan.

Skin preparation

You may be asked to shave the scrotum and groin area at home or it may be done in the operating room. Bathing or showering the morning of surgery, with attention to the genital area, is standard.

What to arrange at home

• Supportive, snug-fitting underwear or a scrotal support to wear after surgery
• Loose, comfortable clothing
• Ice packs (wrapped in cloth) for swelling
• An adult to accompany you home, since you will not be able to drive after anaesthesia
• Time off work or school — usually around one to two weeks for most adults, longer for physically demanding jobs

What Happens During Hydrocele Surgery

The exact steps vary by approach, but the general flow is similar.

Anaesthesia

Hydrocele surgery is most often done under general anaesthesia, where you are fully asleep. Spinal anaesthesia (numbing from the waist down) is another option for adults. In some adult cases with smaller hydroceles, local anaesthesia with sedation may be used. Children receive general anaesthesia.

The operation

After the area is cleaned and sterile drapes are placed, the surgeon makes the planned incision — in the scrotum for most adult hydroceles, in the groin for children with communicating hydroceles. The sac is opened, the fluid is drained, and the testicle is carefully inspected.

The sac is then treated using one of the techniques described earlier — excised, everted (turned inside out), or plicated (folded down with stitches). For communicating hydroceles, the connection to the abdomen is closed.

The surgeon checks for bleeding, places dissolvable stitches to close the layers, and may leave a small drainage tube if the hydrocele was very large. The skin is closed with absorbable stitches that do not need removal.

How long it takes

Most hydrocele operations take 30 to 90 minutes. You then spend one to a few hours in a recovery area before going home the same day in most cases. A short overnight stay is sometimes recommended for larger hydroceles, when a drain is used, or when the patient has other health conditions.

Recovery After Hydrocele Surgery

Recovery is usually straightforward. Some discomfort, swelling, and bruising are expected, and they settle gradually over a few weeks.

The first few days

• Pain. Mild to moderate discomfort is normal for the first three to five days. Paracetamol and a short course of stronger pain medicine, prescribed by the surgeon, usually keep it well controlled.
• Swelling and bruising. The scrotum often looks swollen, sometimes more than before the operation, for one to two weeks. Bruising can spread down to the thighs or up over the lower abdomen. This looks dramatic but is usually harmless.
• Scrotal support. Wearing snug supportive underwear or a scrotal support throughout the day — and sometimes at night — helps reduce swelling and discomfort.
• Ice packs. Cold packs wrapped in a thin cloth, applied for 15–20 minutes a few times a day in the first 48 hours, can reduce swelling.
• Wound care. Keep the wound clean and dry. Most surgeons allow gentle showering within 24–48 hours, with careful drying afterwards. Avoid soaking in baths, swimming pools, or hot tubs until the wound is fully healed.

Returning to normal activities

• Desk work: usually possible within one to two weeks.
• Driving: when you are off strong pain medicines and can perform an emergency stop without discomfort — often around a week.
• Exercise and heavy lifting: avoid for around four weeks, or as advised by the surgeon.
• Sexual activity: usually safe to resume after about three to four weeks, once discomfort has settled.
• Children: tend to recover faster — often returning to school within a week and to sports within two to four weeks, depending on the surgeon’s advice.

Follow-up

A check-up is usually scheduled two to six weeks after surgery to confirm healing and review any concerns. Stitches are absorbable in most cases, so there is no separate removal visit.

Risks and Complications

Hydrocele surgery is considered a safe operation, but like any surgery it carries some risk. Most complications are minor and resolve with time or simple treatment.

Common, usually minor

• Pain and discomfort in the first days
• Swelling and bruising of the scrotum, sometimes lasting several weeks
• Temporary numbness or altered sensation in the scrotal skin

Less common

• Bleeding and scrotal haematoma. Blood can collect inside the scrotum after surgery, sometimes requiring drainage if it is large or expanding. Wearing supportive underwear and avoiding strenuous activity reduces this risk.
• Infection. Wound infection or, less often, infection of the testicle or epididymis can occur. It is treated with antibiotics and, rarely, drainage.
• Recurrence. Fluid can collect again, particularly after simple drainage or less extensive techniques. Recurrence rates are low after standard excision or eversion procedures.
• Reactive hydrocele. A small amount of fluid sometimes reaccumulates temporarily as the tissues heal and settles on its own.
• Chronic scrotal pain. A small number of patients have persistent discomfort that can last months. It is usually mild and improves over time.
• Injury to surrounding structures. Very rarely, the structures that carry sperm (vas deferens) or supply blood to the testicle can be damaged. In children, the inguinal approach is designed to minimise this risk.
• Anaesthetic complications. As with any operation under anaesthesia.

Call the surgical team or seek urgent care if you notice rapidly increasing scrotal swelling, severe pain not controlled by prescribed medicines, heavy bleeding from the wound, a high fever, or signs of wound infection such as spreading redness or pus.

Effect on Fertility and Sexual Function

Most patients ask whether hydrocele surgery will affect their ability to have children or their sex life. The straightforward answer, based on current clinical practice, is that the operation is not designed to alter fertility or sexual function and usually does not do so. The testicle and the structures around it are preserved.

That said, the surgery is performed close to the vas deferens and the blood supply to the testicle, so injury is possible, although uncommon. For men trying to conceive, this is worth discussing with the urologist before surgery. Sexual function typically returns to baseline once healing is complete.

Hydrocele Surgery in Children

Hydroceles in children are usually congenital — present from birth — and of the communicating type. The connection between the abdomen and the scrotum, which normally closes before or shortly after birth, has stayed open and allows fluid to track down.

Watchful waiting first

In the first one to two years of life, most paediatric hydroceles close on their own. Current European Association of Urology paediatric guidance and major paediatric urology practice support a period of observation in this age group, provided there are no concerning features (such as a hernia or a tense, rapidly enlarging hydrocele).

When surgery is offered

Surgery is generally considered when:

• The hydrocele is still present after about 18–24 months of age
• It is large, tense, or changing rapidly
• There is an associated inguinal hernia
• The child is uncomfortable or the appearance is affecting the family’s quality of life

How the operation differs in children

In children, the operation is almost always done through a small groin (inguinal) incision rather than through the scrotum. The surgeon identifies the patent processus vaginalis, ties it off close to the abdomen, and drains any fluid below it. Laparoscopic repair is an option in some centres, especially for hydroceles on both sides.

Recovery in children

Children usually go home the same day. They tend to bounce back quickly — most return to school within a week and to normal play within two to four weeks. Pain is usually well managed with paracetamol and ibuprofen as directed by the team. Parents are typically advised to avoid rough play, bike riding, and contact sports for two to four weeks.

Life After Hydrocele Surgery

For most patients, hydrocele surgery is a one-time operation with lasting results. Once the swelling and bruising settle — usually within four to eight weeks — the scrotum returns to a normal size and feel. The small scar in the scrotum or groin fades over months.

Long-term, there is usually nothing special to do. It is sensible to:

• Keep up regular self-examination of the testicles, particularly for adults, so that any new lump or swelling is noticed early
• See a urologist promptly if a new swelling, pain, or lump appears in the scrotum
• Attend any follow-up appointments arranged by the surgical team

Most patients describe a clear improvement in comfort, mobility, and confidence after recovery is complete.

Frequently Asked Questions

Will my hydrocele come back after surgery?

Recurrence is uncommon after standard excision or eversion procedures. It is more likely after needle aspiration without sclerotherapy or after simple drainage techniques. The urologist will choose an approach with the lowest recurrence risk for your situation.

Is hydrocele surgery painful?

The operation itself is done under anaesthesia, so you do not feel it. Afterwards, mild to moderate soreness for several days is typical and is well controlled with standard pain medicines. Significant pain that does not respond to medication is unusual and should be reported.

How long will the scrotum stay swollen after surgery?

Swelling and bruising are usually most noticeable in the first one to two weeks and gradually settle over four to eight weeks. Wearing scrotal support and using cold packs in the first two days helps. If swelling rapidly increases or the scrotum becomes hard and very tender, contact the surgical team.

Can a hydrocele go away on its own?

In babies and very young children, yes — most communicating hydroceles close in the first one to two years of life. In adults, primary hydroceles rarely resolve on their own, although a hydrocele caused by infection or injury may settle as the underlying problem is treated.

Is a hydrocele dangerous?

A hydrocele itself is usually not dangerous. The reasons for treatment are discomfort, size, appearance, and sometimes uncertainty about what is causing the swelling. However, any new scrotal swelling should be evaluated by a doctor to rule out other conditions, such as a hernia, infection, or testicular tumour.

How long until I can go back to work?

Many adults with desk-based jobs return to work within one to two weeks. Those with physically demanding work or who lift heavy loads usually need three to four weeks. The surgeon will advise based on your operation and job.

Will I have a noticeable scar?

The incision is small — typically a few centimetres — and placed in the scrotum or the groin crease. Over months, the scar usually fades and becomes hard to see.

Can a hydrocele affect fertility?

A hydrocele by itself does not usually affect fertility. The surgery is designed to preserve the testicle and surrounding structures, so it should not normally affect future fertility, although rare complications can occur. If fertility is an important concern, raise it with the urologist before surgery.

What is the difference between a hydrocele and a hernia?

A hydrocele is a collection of fluid around the testicle. A hernia is a bulge of tissue (often a loop of bowel) from the abdomen down through a weakness in the groin. The two can look similar and sometimes occur together, particularly in children. An examination and ultrasound usually distinguish them, and the surgical plan is adjusted accordingly.

Is hydrocele surgery the same in adults and children?

No. In adults, the operation is usually done through the scrotum and treats the fluid sac directly. In children, it is usually done through a small incision in the groin to close the connection between the abdomen and the scrotum. The principles differ because the underlying cause differs.

Conclusion

Hydrocele surgery is a well-established operation with predictable steps and, for most patients, a smooth recovery. The choice between observation, simple drainage, sclerotherapy, and surgery depends on age, size, symptoms, and the underlying cause. In children, time and watchful waiting often do the work that surgery would do in an adult.

If you are preparing for hydrocele surgery, the most useful conversations to have with your urologist are about which surgical approach is planned for your situation, what the recovery will look like for your specific job or activities, and how any concerns about fertility or sexual function fit into the picture. With clear information and a good surgical plan, most people come through the operation comfortably and put the problem behind them.