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Hydrocelectomy: Surgery for Hydrocele of the Testis

Indications for Hydrocelectomy

Disturbing size or pain due to a hydrocele is an indication for hydrocelectomy, see section hydroceles.

Contraindications

Clotting disorders.

Surgical Techniques of Hydrocele Operations

Preoperative Patient Preparation

• Patient positioning: supine position
• General, spinal or local anesthesia
• Perioperative antibiotic prophylaxis, if risk factors for wound infection are present

Surgical Approach for Hydrocelectomy:

Inguinal exposure is necessary for open processus vaginalis, hydrocele of the spermatic cord or if testicular tumor is suspected. Scrotal exposure is done for hydrocele testis. Subsequently, two surgical techniques are available.

Hydrocelectomy with Excision of the Hydrocele Sac:

Incision of the hydrocele sac after complete mobilization of the hydrocele. Partial resection of the hydrocele sac, leaving a margin of 1–2 cm. Care is taken not to injure testicular vessels, epididymis or ductus deferens. The edge of the hydrocele sac is oversewn for haemostasis (von Bergmann's technique) or the edges are sewn together behind the spermatic cord (Winkelmann's or Jaboulay's technique). Hydrocele surgery with excision of the hydrocele sas is useful for large or thick-walled hydroceles and multilocular hydroceles.

Hydrocele Surgery with Plication of the Hydrocele Sac:

The hydrocele is opened with a small skin incision without further preparation. The hydrocele sac is reduced (plicated) by suture Hydrocele surgery: Lord technique. The plication technique is suitable for medium-sized and thin-walled hydroceles. The advantage of the plication technique is the minimized dissection with a reduced complication rate.

Lord technique of hydrocele surgery: the hydrocele sac is reduced by plication sutures.

Complications of Hydrocelectomy

Bleeding, infection. Recurrence of the hydrocele after hydrocelectomy should be below 5%. Damage to the epididymis or vas deferens with infertility. Testicular loss due to complications is rarely possible.

References

Ku u.a. 2001 KU, J. H. ; KIM, M. E. ; LEE, N. K. ; PARK, Y. H.:

The excisional, plication and internal drainage techniques: a comparison of the results for idiopathic hydrocele.
In: BJU Int
87 (2001), Nr. 1, S. 82–4

  Deutsche Version: Operationen der Hydrozele