A hydrocele of the tunica vaginalis occurring within the first year of life seldom requires operation, since it will often disappear without treatment. Hydroceles that persist after the first year or appear later in life usually require treatment, since they show little tendency toward spontaneous regression. All symptomatic hydroceles in adults or in children older than 2 years should be removed. Most hydroceles are painless, and symptoms arise only from the inconvenience caused by their size or weight. The long-continued presence of a hydrocele infrequently causes atrophy of the testicle. Open operation is the method of choice for removing the hydrocele. Aspiration of the hydrocele contents and injection with sclerosing agents are generally regarded as unsatisfactory treatment because of the high incidence of recurrences and the frequent necessity for repetition of the procedure. Occasionally, severe infection can be introduced by aspiration. Simple aspiration, however, often may be used as a temporary measure in those cases where surgery is contraindicated or must be postponed.
The accuracy of the diagnosis must be ascertained. Great care must be taken to differentiate a hydrocele from a scrotal hernia or tumor of the testicle. Ultrasound imaging can be very useful in these cases. A hernia usually can be reduced, transmits a cough impulse, and is not translucent. A hydrocele cannot be reduced into the inguinal canal and gives no impulse on coughing unless a hernia is also present. In young children, a hydrocele is often associated with a complete congenital type of hernial sac.
Either spinal or general anesthesia is satisfactory in adults. General anesthesia is the choice in children. Local infiltration anesthesia is generally unsatisfactory because it fails to abolish abdominal pain produced by traction on the spermatic cord. Uncomplicated hydroceles may be excised as an ambulatory surgical procedure.
The patient is placed on his back on a level table with his legs slightly separated. The surgeon stands on the side of the table nearest the operative site.
The skin is prepared routinely, with particular care given to scrubbing the scrotal area. Iodine should be avoided for preparation of the scrotal skin, since it will cause severe excoriation. The area is draped as for any other operation on the scrotum.
The relationship of the hydrocele of the tunica vaginalis testis to the testicle, epididymis, spermatic cord, and covering layers of the scrotum is shown in figure 1. If the hydrocele is associated with an inguinal hernia, separate incisions are made. If just a hydrocele is present, then after the mass is grasped firmly in one hand so as to stretch the scrotal skin and to fix the hydrocele, an incision 6 to 10 cm long is made on the anterior surface of the scrotum, over the most ...