Hydrocele repair is a surgical procedure used to treat hydrocele, primarily targeting fluid accumulation in the scrotum or inguinal region. Its main goal is to eliminate excess fluid within the tunica vaginalis, repair the defect in the processus vaginalis, and prevent related complications such as scrotal swelling, pain, or interference with daily activities. This surgery is typically performed under local or general anesthesia, with different techniques selected based on the patient's age and severity of the condition.
If left untreated, hydrocele can lead to abnormal testicular development (especially in pediatric patients) or chronic discomfort. Therefore, surgery is considered the standard treatment. Successful surgery can significantly improve quality of life and reduce the risk of recurrence.
There are mainly two types: "Open Surgery" and "Laparoscopic Surgery." Open surgery involves making an incision in the inguinal region or scrotum to directly remove the fluid and repair the defect; laparoscopic surgery uses a three-port approach to enter the abdomen and perform repair with endoscopic instruments. Both methods focus on blocking the communication between the peritoneal cavity and the tunica vaginalis to prevent fluid reaccumulation.
The mechanism involves precise localization of the lesion, such as congenital patent processus vaginalis or acquired dilation due to inflammation. Surgeons choose the most appropriate technique based on the patient's age, lesion location, and nature of the fluid to ensure complete tissue repair.
Suitable for patients diagnosed with hydrocele who exhibit symptoms, including persistent scrotal swelling, increased pain after walking or standing for long periods, or large fluid accumulation causing activity limitations. Particularly for pediatric patients, if fluid persists beyond 6 months after birth without absorption, or in adults with recurrent inflammation leading to worsening hydrocele, surgery is recommended.
Other indications include complex cases with concurrent hernia, or cases of hydrocele recurrence after non-surgical treatments such as aspiration. This surgery can also serve as a diagnostic tool to differentiate hydrocele from other causes of scrotal swelling such as testicular tumors.
The procedure is usually a day surgery, allowing patients to be discharged on the same day. The steps include incision under anesthesia, fluid removal, repair of the defect, and wound closure. The operation time for adults is approximately 1-2 hours; for children, anesthesia and procedure are adjusted according to age.
The concept of "dosage" does not apply to surgical treatment, but surgeons may adjust the extent of surgery based on the size of the lesion. For example, large hydroceles may require an extended incision or special suturing techniques. Postoperative care includes compression bandaging and pain management, which are integral parts of the treatment plan.
Main advantages include:
Compared to traditional drainage methods, surgery can thoroughly restore anatomical structures and prevent fluid reaccumulation. Pediatric patients benefit from a significantly reduced risk of abnormal testicular development after treatment.
Potential risks include: infection, hematoma, wound leakage, nerve injury causing temporary numbness. Serious complications are rare, with an incidence below 2%. However, if postoperative fever exceeds 38.5°C or there is redness and swelling at the wound site, medical attention should be sought immediately.
Rarely, patients may experience testicular ischemia leading to atrophy, or anesthesia-related cardiopulmonary issues. Elderly patients with comorbidities such as diabetes or cardiovascular disease should have their underlying conditions carefully managed to reduce risks.
Preoperative preparation includes discontinuing anticoagulants (such as aspirin) at least one week prior, and completing blood tests and ultrasound assessments. Contraindications include: acute infection, coagulation disorders, systemic infections, or severe cardiopulmonary failure.
Postoperative care involves avoiding heavy lifting for 4 weeks and regular follow-up on wound healing. Patients with autoimmune diseases or skin conditions should inform their doctor before surgery to adjust the surgical plan accordingly.
This surgery does not have direct interactions with other surgical or medical treatments, but attention should be paid to drug interactions, especially with anesthetics and medications the patient is currently taking (such as anticoagulants). Postoperative pain medications should be used cautiously to avoid interactions with chronic disease medications (e.g., antiplatelet drugs).
If the patient is undergoing concurrent procedures such as testicular fixation or other urological surgeries, these should be integrated into a single operation to reduce tissue trauma and anesthesia exposure.
According to multiple prospective studies worldwide, the immediate success rate of hydrocele repair exceeds 95%, with a recurrence rate below 5% over five years. Laparoscopic techniques, with their clear visualization, can also diagnose concurrent hernias, improving diagnostic accuracy.
Systematic reviews show that compared to traditional open surgery, laparoscopic approaches reduce wound infection rates by 40% and increase patient satisfaction. However, these procedures should be performed by experienced urologists to ensure optimal outcomes.
Non-surgical options include:
However, non-surgical methods are associated with high recurrence rates, with aspiration alone leading to recurrence rates of 60-70%. Therefore, surgery remains the definitive treatment. Alternatives are only considered in special cases where immediate surgery is not feasible.
Preoperative assessments include blood tests, cardiopulmonary evaluations, and other basic examinations to confirm fitness for anesthesia and surgery. Patients on anticoagulants (such as aspirin) should discuss with their doctor about discontinuation prior to surgery. On the day of surgery, fasting for 6-8 hours is required to reduce anesthesia risks.
What are common discomforts during recovery, and how can they be alleviated?Postoperative symptoms may include local swelling, mild pain, or itching, which are normal. Pain medications are prescribed to relieve discomfort. Avoid heavy lifting or vigorous activities, and wearing appropriate compression underwear can reduce swelling. If fever, severe pain, or wound redness occurs, seek medical attention immediately.
When can normal activities be resumed after surgery?Light activities such as walking can usually begin 1-2 days post-surgery, but strenuous activities should be avoided for at least 4 weeks. Return to full-time work varies but generally takes 1-2 weeks. Progress should be based on individual wound healing and follow the physician's instructions to gradually increase activity levels.
Is the success rate and recurrence risk high for hydrocele surgery?Modern surgical techniques have a success rate exceeding 95%, with a recurrence rate below 5%. However, patients with severe anatomical abnormalities or habits such as chronic coughing or heavy lifting that increase intra-abdominal pressure may have higher recurrence risks. Regular follow-up allows early detection of issues.
Are all hydroceles required to be operated on? When can non-surgical observation be considered?If the hydrocele is asymptomatic and stable, and other complications are ruled out, doctors may recommend observation. However, if the fluid continues to enlarge, causes pain, affects daily activities, or if testicular pathology is suspected, surgery is indicated. The specific treatment plan should be based on ultrasound and other diagnostic assessments.
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