Procedure · Men’s Health

Hydrocoele repair

A hydrocoele is a collection of fluid around the testicle that can make the scrotum swollen and heavy. It is repaired through a small scrotal incision so the fluid does not build up again.

What are the indications for a hydrocoele repair?

A small hydrocoele without symptoms does not need treatment. Repair is generally recommended for the following reasons:

  • A scrotal swelling that is enlarging or uncomfortable
  • A feeling of heaviness or dragging in the scrotum
  • Interference with physical activity
  • Concern about appearance through clothing

What are the alternatives?

  • Observation — Leaving a small or painless hydrocoele alone.
  • Needle aspiration — Draining the fluid with a needle; however it usually refills quickly and can cause bleeding and infection, so not routine practice.

What happens before surgery?

You will be asked to attend for a pre-operative assessment approximately 2-3 weeks before surgery, where blood tests and an ECG are typically performed to ensure the procedure takes place with minimal risk. Most patients should continue regular medication, although certain drugs should be stopped prior to surgery. Please tell the team if you take blood thinners or have any implants, a pacemaker or a history of MRSA.

On the day of surgery you should avoid eating for six hours before, and drink only clear fluids within two hours of the procedure. You will be given a gown and compression stockings to wear, your consent will be confirmed, and an anaesthetist will discuss your anaesthetic and pain relief.

What does the procedure involve?

  • Performed under general or spinal anaesthetic, usually with a local anaesthetic spermatic cord block.
  • A small incision is made in the scrotum and the fluid is drained.
  • The hydrocoele sac is bunched up and stitched, closed behind the testicle, or removed if its wall is thick.
  • The skin is closed with dissolvable stitches that disappear over 3-4 weeks.
  • A turban dressing or scrotal support is applied at the end of the procedure.

What are the side-effects?

  • Swelling, bruising and discomfort of the scrotum (almost all patients).
  • A bulky feeling from the bunched-up sac (almost all patients).
  • A blood collection (haematoma) that resolves slowly or needs drainage (5-10%).
  • Infection of the wound or testicle needing antibiotics or drainage (5-10%).
  • Recurrence of the fluid collection (1-2%).
  • Injury to the epididymis, vas or blood supply, or chronic pain (less than 1%).

What happens after surgery?

Most men wake up with minimal pain due to the placement of a local anaesthetic block, which usually lasts for 6-8 hours post-op. After this you should take simple painkillers such as paracetamol if needed. You can remove the turban dressing or scrotal support after 24 hours, following which you should shower and carefully dry the area, before applying Vaseline® or E45® cream to the wound. You should wear supportive, tight-fitting underwear and avoid heavy lifting and strenuous exercise for at least four weeks.

A discharge letter will be shared with your GP and an outpatient review appointment will be made for 6-8 weeks.

British Association of Urological Surgeons

Patient information leaflet

Read the British Association of Urological Surgeons (BAUS) leaflet: Repair of a hydrocele.

View the BAUS leaflet