Small hydroceles are diagnosed with physical exam in the office, and often a scrotal ultrasound is used for confirmation. Observation is usually all that is needed for small hydroceles that are the size of a racquet ball or smaller. Larger hydroceles tend to be uncomfortable; in this case a hydrocelectomy or office drainage may be recommended.
Hydrocelectomy is a surgical procedure to treat a hydrocele and prevent its recurrence. Office drainage of a hydrocele, while technically easy, carries a high rate of recurrence and is not recommended. Recurrence rates of hydrocele after surgery are much lower.
The procedure is performed under general anesthesia. In infants, a small incision is made in the groin (area where the upper thigh meets the trunk), and in adults, the incision is made horizontally on the scrotum. The fluid is drained after removing part of the hydrocele sac; the remaining sac is reconfigured behind the testicle and sutured closed. The incision is closed with dissolvable stitches.