Hydrocelectomy, also called hydrocele repair, is a surgical procedure that aims to remove or repair a hydrocele, a sac of fluid that forms around a testicle, causing swelling and pain.
Hydrocelectomy is like all other surgeries—risky, and one may get hurt during the procedure, react to the anesthesia, develop breathing problems, bleed, get infections, or have blood clots.
It is of paramount importance that one take the precautions necessary to ensure that these do not occur, but again, like all surgeries, you cannot anticipate everything. Something could go wrong when you least expect it. It could be something to do with the equipment or the patient himself. The risks and potential complications vary according to the procedure, and other common complications are common across all types of surgeries.
This condition is mostly congenital or present at birth.
Testicles develop in the abdomen. Few weeks before the baby is born testicles descend to the scrotum. After this movement the tube usually closes. If the tube does not close then the fluid from the abdomen may collect in the scrotum. This causes a communicating hydrocele. The pathway between the abdomen and scrotum is wide open hence it is called as communicating.
As the fluid often returns to the abdomen after lying down hence this type of hydrocele is bigger in the evening and smaller or absent in the morning. When the fluid stays inside a closed sac and is not gradually absorbed into the body it is termed as non communicating hydrocele. Men especially over the age of 40 can develop this due to an infection or if the blood or fluid gets blocked inside the spermatic cord or if there is an injury to the scrotal area .
Radiation therapy can increase the risk for developing hydrocele in adult males.
Hydrocele growth treatment can give rise to many complications. Aspiration of hydrocele fluid and use of medication may lead to problems such as fibrosis, infection, pain in scrotal region or recurrence of hydrocele. Infection is rare but an incorrect operation may give rise to it.
The following are the types of complications that could occur when this surgery is done.
Due to the close proximity of the incision in hydrocelectomy to sensitive organs like the testes and its environs, a single badly-aimed incision could cause problems that no one can foretell.
1. Blood Clots
Blood clots may form in the legs because a patient is required to stay in bed for some time after the surgery and the lack of circulation this results in is dangerous. This is why one is encouraged to take walks after some time after a hydrocelctomy procedure. This helps with the circulation and gets the blood running normally after all those injections and medicines you've gotten.
The clots that form in the legs are likely to travel upwards to the lungs and cause blockage in them, resulting in respiratory problems and making it harder for one to take in oxygen. Blood clots can lead to heart attacks and strokes which may be fatal at once or in the long term.
2. Infection at The Incision
After the procedure, a patient may develop a hernia at the incision. Apart from causing you great pain and delaying the healing of the cut, it will also cause internal infections if it’s not curbed in time.
The signs that could tell you that you have an infection include increasing pain, swelling, and redness. The wound will have pus leaking out of it. These automatically mean that an infection is in all likelihood the explanation for the activity. Infection after the surgery can be expected to be <1%.
3. STDs and Their Risks
If you decide to have sex, make sure it isn't before a month is over after the surgery. This is because after undergoing the hydrocelectomy procedure, you are liable to get infections from other people. These may include STDs and other genital infections.
Normally, they can be curbed easily but it may be not so easy to treat the infections if they are directly transmitted to the site of your incision.
4. Bleeding at The Incision Site
Bleeding could occur soon after the surgery. This is not very uncommon, but it portends worse things like clotting and other complications. It is recommended that one go back to the hospital or clinic to ensure that the bleeding doesn't develop into something else. While this will often require a second operation, the surgery won't be complicated.
Bleeding may occur due to inadequate hemostasis of the superficial fascia, damage to the pampiniform plexus or from the edges of the excised distal hernia sac. Later this bleeding can result in scrotal hematoma when the blood travels via the processes vaginalis. This complication is <1%. Bleeding can occur over a course of several weeks.
Having said all that, bleeding at the incision site as a possible complication should not worry you much because the incision made for a hydrocelectomy is a small one and the fearsome risk is actually very small.
5. Injury to the Spermatic Vessels
The testes, which produce semen, can be damaged during the surgery, and infertility could result. Aside from this problem in sperm production, you could also develop trouble in your urinary tract after some time. Bilateral injury to the vas deferns due to an incorrcet hydrocele operation procedure can also result in infertility, although it is very rare but it is considered as one of the side effect of this surgery.
The spermatic vessels are very important and their damage can cause later sorrow, particularly for people who want babies.
6. Allergy from the Anesthesia
This is a common problem across all surgeries. Anesthesia could cause unpleasant allergic reactions and even death. If the anesthesia causes an allergic reaction in the testes, these organs could swell and hurt, among other undesirable effects.
It is important that you talk to your doctor about your allergies, if any, and possible risks of anesthesia.
7. Irritation and Numbness at the Incision Site
If you feel numbness at the incision site after the surgery, do not worry much unless it persists. This is normally caused by the aftereffects of the anesthesia. This reaction is normal enough and should wear off after some time.
The numbness may cause irritation, but even though you feel like scratching yourself, don’t do it. It is not advisable.
8. Recurrence of the Hydrocele
If the procedure is not done properly, the hydrocele is likely to recur. If this happens, it is imperative that you go back for another surgery to ensure that the hydrocele is repaired so that nothing bad happens.
Yet fear not. The recurrence of the hydrocele is normal in some cases, and a second repair will most likely do the trick.
9. The Pain
There will be pain after the surgery is over, which is why you are advised on how to deal with it. It will not be hot, unbearable pain—just a little tingling that causes you to itch and feel the need to scratch your scrotum or dip them in water.
For this, you can have an ice pack to solve the problem. But don’t hold it against the scrotum for longer than fifteen minutes a day.
10. Scrotal edema
It is a common complication of surgery. Postoperative swelling may occur without indication of recurrent hydrocele or hernia. Almost 5% of patients may experience scrotal edema. However this should subside within two weeks.
11. Iatrogenic injury
Damage to the seminal pathway structures may occur during inguinal hernia or hydrocele repair. Abdominal viscera, intestine, bladder, ovary or uterus may be contained in the hernia sac. Gentle mobilization will help in protecting these sac contents. In the transcrotal hydrocele approach, damage to the testicle is possible.
With excessive electrocautery use or excision of the hernia sac or hydrocele can cause injury to the vas deferens or epididymis. The inguinal sac may contain outright portions of the vas deferens and epididymis as well as embryonal cells of the spermatic cord contents. Future fertility is affected if any of these structures along the spermatic pathways is damaged.
12. Sensory changes
The ilioinguinal nerve passes lateral to the internal ring and the genitofemoral nerve passes through the internal ring. These nerves are particularly at risk during the surgery. Due to heat – transfer from electro-cautery or compression or due to post operative swelling or scarring, a trauma may occur. This trauma can produce sensory neuropathy. According to a survey, zero to ten days following the surgery, almost 2-5% of children reported numbness in the thigh or groin. In almost 92% of cases this issue gets resolved by 8 months. In >2% of the patient’s chronic pain may occur less than 3 months however this incidence is infrequently reported.
13. Reactive hydrocele
The two entities postoperative hydrocele and scrotal edema may be confusing although they should be differentiated. Following the surgery the distal sac will produce fluid. In case of larger hernias larger amount of fluid is produced than it may be resorbed and accumulate as postoperative hydrocele.
14. Testicular atrophy
It is a rare but potentially devastating outcome of the surgery. In 20-40% of cases litigation of testicular artery may cause testicular atrophy. This risk increases in premature infants and children. This may be due to compression of gonadal vessels by intra-abdominal contents in the inguinal canal.
15. Testicular ascent/ Iatrogenic cryptorchidism
Iatrogenic undescended testes or testicular ascent is a rare complication. It occurs due to either mechanical tethering of the testis or due to post-operative scarring. This prevents the growth of spermatic cord with the rest of the body. The incidence of iatrogenic cryptorchidism is more in premature infants. However this risk can be reduced by confirming proper position of the testis in the scrotum and if required anchoring the testis in the scrotum before closing.
This is the most common long term consequence of surgery. In uncomplicated open repairs the risk is 0.5-1% and in premature infants it is 2%. The chances of recurrence depend on a variety of surgical and patient factors. It was reported that when recurrence occurred they were mostly right- sided, direct and discovered at six months to five years of age.
17. Other Risks
The following can occur after the surgery is done. Go to the doctor when you see the following symptoms:
- Chest pains or respiratory problems particularly difficulties in breathing
- If you get a fever of 38.0 degrees Celsius, whose equivalent in Fahrenheit is 100.4
- Symptoms of infection that include redness, swelling, warmth, worsening pain or stinking urine
- If the incision is bleeding
- If the pain gets worse and the medicine for the pain doesn’t work
Preparing for the surgery
Inform the doctor about all the medicines you take including the herbal and other supplements. The doctor might tell you to stop taking those medicines before the surgery. 8 hours before surgery do not eat or drink.
On the day of surgery:
Before the surgery- IV line is put into the vein in your hand or arm which will deliver fluid and medications. Anesthesia is given so that you do not experience pain during the surgery. To help you breath a tube may be inserted in your throat.
During the surgery- incision is made in the scrotum. In the incision a thin tube is placed to drain the fluid out of hydrocele.Tissue around the hydrocele that forms a sac is either removed or repositioned. This is done to prevent building up of fluid again. With stitches or surgical strips the incision is closed.
After the surgery-you are sent to a room for recovery from anesthesia and a nurse will monitor you to make sure that you do not experience any pain. Ice pack may be applied to the surgical area which will help reduce swelling. To help relieve pain and swelling and prevent any injury you may be given a jockstrap to wear.
Recovery at home: apply an ice pack or cold compress to the scrotum no longer than 15 minutes. Use this cold pack for two days. This will help reduce swelling. Take the medicine prescribed by the doctor. Take care of the incision. Avoid any strenuous exercise or lifting heavy objects.
It should not be difficult to deal with the risks if the doctor knows what he or she is doing. The procedure is easy and should be free of the complications that come with surgery but if they do occur, they can be mostly dealt with.
The risks are minimal and if symptoms occur, they should not worry you. At least most of them. If you have an allergic reaction, you should go to the hospital immediately. Also, you should, at all times, follow the instructions given to you by your doctor.