Hydrocele Repair — Surgical Treatment of Scrotal Fluid Collection

What is a hydrocele?

A hydrocele is a collection of fluid within the thin membrane (tunica vaginalis) that lines the space around the testicle. It typically presents as a smooth, non-tender swelling of one side of the scrotum. The swelling is usually soft and transilluminates — meaning a light shone through it passes easily, distinguishing it from solid masses.

Most adult hydroceles are primary, meaning they arise without an identifiable underlying cause. When a hydrocele develops alongside testicular pain, rapid enlargement, or other concerning features, investigation to exclude an underlying testicular pathology — including ultrasound — is undertaken first.

Who needs hydrocele surgery?

Hydrocele repair is offered when the hydrocele causes significant symptoms or the patient prefers definitive treatment. Common reasons to proceed include:

• A large hydrocele causing discomfort, a dragging sensation, or difficulty with normal activities
• Difficulty with personal hygiene due to the size of the swelling
• Psychological or aesthetic concerns related to the swelling
• Patient preference for a permanent solution rather than ongoing monitoring

Small, asymptomatic hydroceles may be safely observed without intervention.

What to expect: before, during, and after

Before the procedure

Blood tests are taken as standard. A scrotal ultrasound will typically have been performed to confirm the hydrocele and assess the underlying testicle. You will be asked to fast before the procedure. Guidance about blood-thinning medications will be given if relevant.

During the procedure

An incision is made in the scrotum. The hydrocele sac is opened, the fluid drained, and the sac is then either plicated (folded back on itself — Lord’s procedure) or excised and sutured (eversion/Jaboulay procedure), depending on the size and nature of the sac. The incision is closed with dissolving sutures. A dressing and supportive underwear are applied. The procedure takes approximately 30–45 minutes and is performed as a day case.

After the procedure

You will go home the same day. Scrotal swelling and bruising are normal and typically peak in the first one to two weeks before gradually settling. Wearing supportive underwear or a scrotal support is recommended during the recovery period. Analgesia can be taken as directed. Strenuous activity should be avoided for two weeks.

Results and recovery

Surgical repair has a high rate of success in permanently resolving the hydrocele. Recurrence is uncommon after properly performed surgery. Residual scrotal swelling caused by post-operative inflammation — rather than fluid — can persist for several weeks and should not be confused with recurrence.

If a secondary hydrocele was treated — meaning one that developed because of an underlying condition — management of the underlying cause is also addressed. Follow-up is arranged as appropriate.