Hydrocoele surgery at York Hospital

What conditions does hydrocoele surgery treat? 

A hydrocoele develops when fluid builds up between the layers of tissue that surround the testicle. The testicle is normally enclosed in a smooth protective sac that produces a small amount of fluid to allow it to move freely. If the balance between fluid production and drainage is disrupted, excess fluid accumulates and a hydrocoele forms. 

Hydrocoeles are common in newborn boys, affecting around 1 in 10. Many resolve on their own without treatment. In adults, they can develop after an infection, injury, or inflammation, and about 1% of men will develop one at some point. 

Surgery is not always needed. A small hydrocoele that causes no symptoms can be monitored without treatment. Surgery is recommended when the hydrocoele: 

• Causes pain or significant discomfort 
• Makes walking or normal daily activities difficult 
• Causes distress because of the appearance or size of the scrotum 

In infants, if a hydrocoele is still present after 12 months of age, surgery is usually advised as it is unlikely to go away on its own. 

What are the benefits? 

The aim of surgery is to permanently resolve the hydrocoele and stop the fluid from returning. The benefits of hydrocoele surgery include: 

• Relief from pain or discomfort 
• Reduction in scrotal size 
• Cosmetic improvement to the appearance of the scrotum 

The alternative to surgery is draining the fluid using a needle (aspiration). This removes the fluid but the fluid returns within a month or two, and the procedure may also introduce infection. It is not considered a curative treatment and is not standard practice. Watchful waiting (monitoring without treatment) remains an option if the hydrocoele is not causing problems. 

Types of hydrocoele surgery 

The approach your surgeon recommends depends on the type and characteristics of your hydrocoele. 

Repair (plication) involves gathering and bunching up the fluid sac using dissolvable stitches and closing it behind the testicle. This prevents fluid from building up again. 

Removal (excision) involves taking the sac out completely. This is more commonly used when the sac wall is particularly thick. 

Sometimes, the repair and removal approaches are combined, depending on what the surgeon finds during the procedure. 

If both testicles are affected (bilateral hydrocele), both sides can usually be treated through a single incision in the same operation. 

In infants, a hydrocele may involve an opening between the scrotum and the lining of the abdomen (called a communicating hydrocele). In this case, the operation focuses on closing this opening rather than simply removing the fluid sac. 

Before the operation 

Before your surgery, you will attend a pre-operative assessment. A nurse will take a health and anaesthetic history and arrange any investigations needed, such as blood tests or an ECG (a test that checks your heart). 

On the day of surgery, your surgeon and anaesthetist will speak with you before the procedure. Your surgeon will confirm which side is being treated and mark the site with a pen. You will be asked to sign a consent form if you have not already done so. 

Tell the medical team before your operation if you: 

• Take blood-thinning medication (such as warfarin, aspirin, clopidogrel, rivaroxaban, or dabigatran) 
• Have an implanted device such as a pacemaker, a joint replacement, or a heart valve 
• Have had a previous MRSA infection 
• Have any known allergies 

You may be given compression stockings (TED stockings) to wear and a blood-thinning injection called heparin on the day of surgery to reduce the risk of blood clots forming. Your team will advise whether you need to continue these after going home. 

Before coming into hospital, have a bath or shower. Do not shave the operation site yourself; this will be done by staff before the procedure. 

Arrange for a responsible adult to take you home by car or taxi and to stay with you for the first 24 hours after surgery. 

What happens during the procedure? 

Hydrocoele surgery is most often performed under a general anaesthetic (medicine that puts you fully to sleep). A spinal anaesthetic, which numbs everything from the waist down, is an alternative. Local anaesthetic is occasionally used but is less common. 

You may be given an antibiotic injection before the start of the procedure to reduce the risk of infection. 

Your surgical team will: 

• Make a small cut (incision) in the scrotum, or in the groin if the hydrocele is connected to the fluid in the abdominal cavity 
• Drain the fluid from around the testicle 
• Either gather and close the sac with dissolvable stitches (repair) or remove the sac entirely if its walls are thick (removal); occasionally both techniques are combined 
• Inject local anaesthetic into the wound area to help manage pain in the hours immediately after waking up 
• Close the skin with dissolvable stitches, which will disappear on their own within two to three weeks 
• Provide a scrotal support for you to wear after the procedure 

Recovery from hydrocoele surgery 

In hospital 

Hydrocoele surgery is planned as a day case, so you should be able to go home on the same day. In rare cases, if recovery takes longer than expected, an overnight transfer to another ward may be needed. 

After the operation, you will wake up in a recovery room where nurses will monitor your blood pressure and pulse and make sure you are comfortable. You will be offered refreshments when it is safe to do so. 

You must have an adult available to collect you by car or taxi. Do not drive yourself after having an anaesthetic. 

At home 

You are likely to feel more tired than usual and have some mild discomfort in the groin for several days. Swelling and bruising in the scrotum are common and typically settle within two to three weeks. 

To manage at home: 

• Take paracetamol or ibuprofen as directed to manage pain in the first few days 
• Apply an ice pack wrapped in a cloth to the area to help reduce swelling; do not place ice directly on the skin 
• Wear the scrotal support provided, or use supportive underwear or cycling shorts if more comfortable 
• You may shower 24 hours after surgery, if your surgical team advises this is safe; avoid baths for the first week 
• Pat the wound dry gently with a clean towel for the first seven days 
• Do not drink alcohol for at least 48 hours after the operation 

Returning to normal activities: 

• Walking: begin increasing activity gently from the first few days; regular walking supports circulation and recovery 
• Work: Most people return to work 1-2 weeks after surgery.  However, returning to work depends on the nature of your work and how quickly your recover.  If you have a sedentary job you may be able to return within 4-7 days.  If your job involves heavy lifting then you may need 2-4 weeks off.  
• Heavy lifting and strenuous exercise: avoid for a minimum of 2 to 4 weeks. 
• Driving: when you are confident you can perform an emergency stop without pain or hesitation; one to two weeks is typical; check with your insurer before driving again 
• Sexual activity: safe once you feel comfortable, though it may be uncomfortable in the first week or two 

Risks and complications 

Hydrocoele surgery is a straightforward procedure and complications are uncommon. Your surgeon will discuss the risks relevant to your situation before the operation. 

Expected in almost all patients: 

• Swelling, discomfort, and bruising of the scrotum lasting several days to a few weeks 
• The treated testicle feeling bulkier or larger than the other side; this is permanent and results from the way the sac is repaired or removed 

Affecting between 1 in 10 and 1 in 50 patients: 

• Haematoma: a pocket of blood collecting around the testicle or wound; most settle on their own, but some require a further procedure to drain 
• Infection at the wound site or in the testicle; treated with antibiotics or, occasionally, with surgical drainage 

Affecting between 1 in 50 and 1 in 250 patients: 

• Recurrence: the hydrocoele returning 
• Accidental injury to nearby structures: the epididymis (the small tube attached to the back of the testicle that carries sperm), the vas deferens (the tube that carries sperm from the testicle), or the blood supply to the testicle 
• Chronic pain in the testicle or scrotum 

General surgical and anaesthetic risks (between 1 in 50 and 1 in 250): 

• Complications related to the anaesthetic or cardiovascular system, including chest infection, blood clots in the legs (deep vein thrombosis or DVT), or clots on the lungs; your anaesthetist can give you a personal estimate of your risk 

If bruising, swelling, or pain is getting progressively worse day by day rather than settling, contact your surgical team for advice. Go to A&E immediately if you notice significant bleeding soaking through the dressing, chest pain with shortness of breath, or sudden severe symptoms. 

Seek advice from your GP if you develop a temperature, increased redness, or discharge at the wound site. 

Frequently asked questions 

Do I need surgery if I have a hydrocoele?
Not necessarily. A small hydrocoele that causes no pain or difficulty can be monitored without treatment. Surgery is recommended when the hydrocoele is causing pain, affecting your ability to walk or carry out daily activities, or causing distress. 

Can the fluid just be drained with a needle?
Draining the fluid using a needle (aspiration) is possible, but it is not a lasting solution. The fluid returns within a month or two, and the procedure carries a risk of introducing infection. Surgery is the only approach that prevents the fluid from building up again. 

Will my testicle feel different after surgery?
Yes. After hydrocoele surgery, the treated testicle will always feel bulkier than the other side. This is a permanent result of the way the fluid sac is repaired or removed, and is expected in almost all patients. 

When can I return to work?
 Most people with a desk-based job are ready to return within four to seven days, though some may need up to two weeks. If your work is physical or involves heavy lifting, you will need to wait longer. Your surgical team will advise based on your individual recovery. 

When can I drive again?
You can drive once you are confident you can carry out an emergency stop without pain or hesitation. For most people this is one to two weeks after surgery. Check with your insurer before driving, as there may be specific conditions on your policy following a surgical procedure. 

What should I watch for when I get home?
Contact your surgical team or GP if pain, swelling, or bruising is getting worse rather than gradually settling, or if you develop a temperature, increased redness, or discharge from the wound. Go to A&E immediately if you have significant bleeding, sudden chest pain with shortness of breath, or any sign of a serious complication.