Successful Right Hydrocelectomy for Chronic Right Hydrocele in an 80 Y.O. Male

Chief Complaints

An 80-year-old male patient with a body mass index (BMI) of 21 presented to the Urology Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of right-sided scrotal swelling.

The patient had a history of hypertension and a previous right open inguinal hernia repair performed in the past at another hospital. No other significant comorbidities were reported.

On examination, the patient was conscious, coherent, and oriented to time, place, and person. He presented with right-sided scrotal swelling. The scrotum was found to be enlarged, consistent with a hydrocele. Both testes were palpable and felt normal in consistency. A small swelling was also noted in the left inguinal region, suggestive of a left inguinal hernia. No signs of acute inflammation were observed.

Upon admission to PACE Hospitals, the patient was thoroughly evaluated by the Urology team, including a detailed review of his medical history and a comprehensive clinical examination. He presented with right-sided scrotal swelling. Based on the initial assessment, a provisional diagnosis of right hydrocele was made.

The patient was further evaluated with relevant investigations, including scrotal ultrasonography, which confirmed a gross chronic right hydrocele with internal echoes, moderate left scrotal fluid collection suggestive of a chronic hydrocele, bilateral epididymal cysts, scrotal wall thickening, and a left inguinal hernia with herniation of bowel and omentum through a defect in the left inguinal region. Cardiac evaluation revealed normal chamber sizes with good ventricular function and no significant abnormalities.

Based on these confirmed findings, the patient was advised to undergo Right Hydrocele Treatment in Hyderabad, India, under the expert care of the Urology Department.

After a detailed consultation with Dr. Abhik Debnath, Consultant Laparoscopic Urologist, a comprehensive evaluation was conducted focusing on the patient’s presentation of right-sided scrotal swelling. Clinical examination and diagnostic assessment confirmed the presence of a right hydrocele with an associated small left inguinal hernia and hypertension, with no evidence of acute scrotal infection or other significant acute pathology.

It was determined that right hydrocelectomy was the most appropriate intervention to relieve scrotal swelling, improve patient comfort, and prevent recurrence or further complications related to the hydrocele. The left inguinal hernia was noted as a coexisting condition and kept under observation, with no immediate surgical intervention planned during this admission.

The patient and his family members were informed about the diagnosis of right hydrocele with small left inguinal hernia, the planned surgical management, the associated risks, benefits, and expected outcomes, and consent was obtained for proceeding with surgical treatment.

Following the decision, the patient was scheduled to undergo Right Hydrocelectomy Surgery in Hyderabad at PACE Hospitals, under the expert care of the urology department.

The procedure involved the following steps:

• Anaesthesia and Positioning: The patient was taken to the operating room and placed in a supine position. Under strict aseptic precautions, spinal anaesthesia was administered. After achieving an adequate anaesthetic effect, the surgical field was cleaned and draped in a sterile manner.

• Scrotal Incision and Exposure: A scrotal incision was made over the right hemiscrotum. The layers were carefully dissected to expose the tunica vaginalis sac containing the hydrocele fluid.

• Delivery and Opening of Hydrocele Sac: The hydrocele sac was isolated and delivered into the operative field. The tunical sac was then carefully opened, and clear serous fluid was drained completely. The right testis was inspected and found to be normal.

• Sac Management (Eversion and Excision): The hydrocele sac was everted to prevent recurrence, and redundant sac tissue was managed appropriately. The edges of the sac were then sutured meticulously to maintain proper anatomical positioning.

• Haemostasis and Closure: Complete haemostasis was achieved to ensure no active bleeding. The surgical site was irrigated, and layers were closed in a standard fashion. A sterile dressing was applied, and the patient was shifted to recovery in stable condition.
  

The patient’s intraoperative and postoperative course was uneventful, with smooth recovery and no complications noted during the hospital stay. Postoperatively, he was managed with adequate pain control for surgical site discomfort, measures for prevention of infection, and supportive care to reduce inflammation and promote wound healing. Urinary catheter care was provided with monitoring of urine output and prevention of urinary retention, along with scrotal support to minimize edema and improve comfort. Early mobilization was encouraged to aid recovery. The patient was discharged in stable condition.

Upon discharge, the patient was prescribed medications to prevent postoperative infection for a short duration, control postoperative pain and fever, and reduce inflammation to promote wound healing and decrease swelling. Supportive treatment was advised for gastric protection during recovery, along with therapy to improve urinary flow and reduce the risk of urinary retention. He was advised to continue his regular blood pressure medications as per the prior regimen

The patient was advised to continue a normal diet as tolerated. Scrotal support using tight-fitting underwear was recommended to reduce swelling and improve comfort. Careful handling and maintenance of the urinary catheter were advised to prevent blockage or infection until removal as instructed.

The patient was instructed to contact the emergency ward at PACE Hospitals in the event of an emergency or if symptoms such as fever, severe groin or scrotal pain, or catheter blockage.

The patient was advised to have the catheter removed in their hometown after 1 day under the supervision of a doctor and to return for a follow-up visit with the Urologist in Hyderabad at PACE Hospitals after 3 days for dressing and drain removal.

This case highlights a right hydrocele with an associated small left inguinal hernia in a patient with hypertension, managed surgically with right hydrocelectomy under spinal anaesthesia. The procedure was successfully performed without complications, and intraoperative findings confirmed a clear hydrocele sac with a normal testis. The postoperative course was uneventful, and the patient recovered well with a stable clinical status at discharge.

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