Repair of hydrocele (hydrocelectomy) at North Downs Hospital in Caterham

Repair of hydrocele is an operation that removes or repairs a fluid filled sac surrounding the testicle, called the hydrocele, to prevent further fluid accumulating.

What causes a hydrocele?

A hydrocele is caused by the accumulation of fluid in the sac surrounding the testicle, known as the tunica vaginalis. Common causes include:

• Congenital factors - in newborns, hydroceles may occur due to incomplete closure of the processus vaginalis during foetal development.

• Injury or trauma - physical damage to the scrotum can lead to fluid buildup.

• Infections or inflammation - conditions like epididymitis or orchitis can trigger hydrocele formation.

• Systemic diseases - rarely, hydroceles may be associated with kidney or liver disorders that affect fluid balance.

• Post-surgical complications - hydroceles may develop after procedures involving the scrotum or groin.

Types of hydroceles

Hydroceles are classified into two main types:

• Communicating hydrocele - occurs when the processus vaginalis remains open, allowing fluid from the abdominal cavity to flow into the scrotum. This type is common in infants and may fluctuate in size throughout the day.

• Non-communicating hydrocele - results from fluid trapped in the scrotal sac due to the closure of the processus vaginalis. It typically remains constant in size and is more common in adults.

Pre-operative ultrasound scans

Pre-operative ultrasound scans are a crucial step in ensuring accurate diagnosis and effective planning for hydrocele repair surgery. These scans provide detailed imaging of the scrotal area, allowing healthcare providers to:

• Confirm the diagnosis - differentiate hydroceles from other conditions, such as inguinal hernias, testicular tumours, or varicoceles.

• Assess the size and location - determine the extent of the hydrocele and its impact on surrounding structures.

• Identify complications - detect any associated issues, such as infections or inflammation, that may influence surgical planning.

• Guide surgical approach - help surgeons decide on the most appropriate technique, whether it’s open hydrocelectomy, Lord’s plication, or Jaboulay procedure.

What does the procedure involve? 

Hydrocele repair surgery is performed to remove or repair a fluid-filled sac surrounding the testicle, known as a hydrocele. The procedure aims to prevent further fluid accumulation and alleviate discomfort or swelling.

Recent studies have highlighted alternative approaches, such as aspiration and sclerotherapy, which may be considered for patients at high surgical risk. However, hydrocelectomy remains the gold standard for long-term resolution due to its lower recurrence rates1.

What happens during the procedure?

The surgeon begins by making a small incision in the scrotum to access the hydrocele. The fluid within the sac is drained, and the sac is either turned inside out and stitched to prevent re-accumulation or removed entirely, depending on the surgeon’s assessment.

How to prepare for a hydrocele repair

Preparation steps include:

• Medical evaluation - your doctor will review your medical history and perform a physical examination.

• Medication review - inform your healthcare provider about any medications or supplements you’re taking, especially blood thinners.

• Fasting - avoid eating or drinking for at least six hours before surgery if general anaesthesia is planned.

• Pre-operative tests - blood tests, urine tests, and imaging may be conducted to ensure fitness for surgery.

• Clothing - bring tight-fitting underwear for post-operative support to reduce swelling.

Surgical techniques for hydrocele repair

Hydrocele repair surgery involves removing or repairing the fluid-filled sac. Techniques include:

• Open hydrocelectomy - the surgeon makes an incision in the scrotum to drain the fluid and either remove or reshape the sac. It has a high success rate, long-lasting results, and low recurrence risk.

• Lord’s plication - the sac is folded (plication) and stitched to reduce its size without complete removal. It is a minimally invasive open surgical technique with a shorter recovery time. 

• Jaboulay procedure - the sac is turned inside out and stitched to prevent the reaccumulation of fluid. It is an open surgical approach effective for larger hydroceles.

• Laparoscopic hydrocelectomy - a minimally invasive approach using small incisions and a camera-guided procedure. It offers reduced post-operative pain and a faster recovery.

What to expect after a hydrocele repair

• Immediate recovery - you may experience swelling, bruising, and mild discomfort in the scrotal area.

• Pain management - painkillers or anti-inflammatory medications will be prescribed.

• Wound care - keep the surgical site clean and dry, and follow your doctor’s instructions for dressing changes.

• Activity restrictions - avoid strenuous activities, heavy lifting, and sexual intercourse for at least two weeks.

• Follow-up - attend scheduled appointments to monitor healing and address any concerns.

How long will it take to recover from hydrocele repair?

Recovery typically takes seven to fourteen days. During this period, you should avoid strenuous activities, heavy lifting, and sexual intercourse until discomfort subsides. 

Minimally invasive approaches, such as laparoscopic repair, may offer faster recovery times and reduced post-operative pain. However, traditional open repair remains widely used and effective.

Recovery typically follows this timeline:

Week 1 - swelling and discomfort are most pronounced and rest is essential.

Week 2 - symptoms begin to subside, and light activities may be resumed.

Week 3-4 - most patients experience significant improvement and can return to normal routines.

Beyond Week 4 - full recovery is expected, though individual timelines may vary.

How much will I pay for hydrocele repair procedure?

The hydrocele repair surgery cost will depend on the specific type of surgery to remove your scrotal lump.

These guide prices are an estimate of costs and you will receive a formal quotation price following your consultation with one of our surgeons. This formal quote for your hydrocele repair surgery will be valid for 60 days and includes unlimited aftercare.

We have a number of finance options available for our self-pay patients. These include All-inclusive Total Care where a single one-off payment at a pre-agreed price delivers direct access to all the treatment they need for complete reassurance, pay as you go and, interest-free medical finance plans.

Hydrocele repair surgery costs are covered by most medical insurance policies. We advise that you get written authorisation from your insurance provider before commencing your surgery. Here’s a detailed write-up based on your request:

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