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 prominent part of the hydrocele, well away from the testicle that lies inferiorly and posteriorly (Figure 2). The skin, dartos muscle, and thin cremasteric fascia are incised and reflected back together as a single layer from the underlying parietal layer of the tunica vaginalis, which is the outer wall of the hydrocele (Figures 3 and 4).