Hydrocele repair in adults: when surgery helps, what happens and how recovery goes

A hydrocele forms when fluid builds up between the layers of the membrane around the testis, more quickly than it drains away. The scrotum looks swollen on one side or both, usually without pain, and it can feel like a water balloon. An NHS commissioning policy explains that many hydroceles can be watched, with regular examination, particularly when they are small and not bothering the person.

That advice applies only after a clinician has examined you. A new scrotal swelling should not be assumed to be a hydrocele, because lumps from the testicle itself, a hernia, or an infection can look similar. Ultrasound is the standard way to tell them apart, and it also checks the testicle underneath, which can be hard to feel through a large collection of fluid.

• Sudden severe testicular pain is an emergency and needs A&E or 999, because torsion cannot be told apart from other causes without examination.

• A hard lump you can feel in the testicle itself should be seen by your GP promptly.

• A swelling that is growing, painful or tender, or comes with fever, needs assessment soon.

The same policy sets out three approaches. Observation is reasonable when the hydrocele is small or comfortable. Aspiration, where a needle draws off the fluid, gives temporary relief, but the fluid tends to come back and the needle carries a small chance of introducing infection. Sclerotherapy adds an irritant after draining to try to seal the space, and is used in selected cases.

Surgery, usually called hydrocelectomy or hydrocele repair, is considered when the swelling is uncomfortable, is interfering with daily life, has become large, or when people want a lasting result. It is the approach with the lowest chance of fluid returning, although no operation guarantees that.

You will have a pre-operative check, and you may have an ultrasound beforehand if one has not been done. The team will ask about blood thinners and any past scrotal infections. Fasting instructions depend on the anaesthetic and are given in your admission letter.

Plan some practical things in advance. Bring a supportive pair of briefs or a scrotal support, because leaflets recommend one. Arrange for someone to take you home, avoid driving yourself, and think about how much heavy or physical work you will need to cover.

Trust leaflets describe a day-case operation. It is usually done under general anaesthetic or spinal anaesthetic, though some units offer sedation with local anaesthetic. The surgeon makes a small cut in the scrotum, drains the fluid and deals with the sac that produces it so that fluid is less likely to collect again; the exact technique varies, so ask which one your surgeon uses.

Afterwards a dressing is applied and you wear a scrotal support. One day-surgery leaflet describes a medicated net-like dressing with gauze that can be removed after 48 hours. You stay for observation, with the same leaflet giving a minimum of one hour, then you are discharged once you have eaten, drunk and passed urine.

Swelling, bruising and tenderness are expected. They can last days to weeks, and the scrotum may look bigger for a while before it settles. Wear the support as advised, take simple painkillers, and walk a little each day. A leaflet describes keeping the wound dry for 48 hours, showering after that, and avoiding baths for two weeks.

Stitches dissolve by themselves. Heavy lifting and strenuous exercise are usually avoided for around four weeks according to one leaflet, and sex for two to three weeks. Work depends on the job; one trust suggests self-certifying for a week, while another suggests one to two weeks off for desk work. A separate page in this section sets out the timeline.

Common effects are swelling, bruising and discomfort. Leaflets list bleeding into the scrotum, which can form a large bruise called a haematoma and occasionally needs further surgery, wound infection, and blood clots as risks of any operation. The hydrocele can come back, so ask your surgeon how they try to prevent that.

Less often, damage to the structures around the testicle can lead to ongoing pain or a smaller, firmer testicle. The leaflets we retrieved do not give frequencies, so we have not quoted any; ask your surgeon how often they see these problems.

Contact your GP, the surgical unit or NHS 111 if the wound becomes red, hot or leaks pus, if you get a fever, or if the swelling suddenly increases. One leaflet advises A&E for significant swelling with severe pain or heavy bleeding. Call 999 for chest pain, breathlessness or a swollen painful leg.

Questions worth asking: Has an ultrasound confirmed this is a hydrocele? Would watching be reasonable for me? What anaesthetic will be used? What are the chances of it coming back? NHS and private care use the same operation. Some NHS areas restrict surgery to specific criteria, while private care may be quicker and should give an itemised price.