Successful Hydrocelectomy for Moderate Left Hydrocele in a 61 Y.O. Male

Chief Complaints

A 61-year-old male patient with a body mass index (BMI) of 22 presented to the Urology Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of left scrotal pain.

The patient had no known significant past medical history of chronic systemic illnesses such as diabetes mellitus, hypertension, bronchial asthma, tuberculosis, or ischemic heart disease. He had no previous history of similar scrotal swelling or any prior urological surgeries.

On examination, the patient was conscious, coherent, and oriented. General examination revealed no pallor, icterus, cyanosis, clubbing, or lymphadenopathy. On local examination of the scrotum, a left-sided scrotal swelling was present, which was cystic and tense in consistency, mildly tender to palpation, and showed positive transillumination, suggestive of a hydrocele. The overlying skin was normal. The right hemiscrotum was normal, and bilateral testes were palpable and appeared normal. Abdominal examination did not reveal any significant abnormality.

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 left-sided scrotal pain. Based on the initial assessment and clinical findings, a provisional diagnosis of left hydrocele was made.

The patient was further evaluated with relevant investigations, including complete blood picture, which was within normal limits, serum electrolytes which were within normal limits, renal function tests including serum creatinine which remained within normal range, coagulation profile including PT, INR, bleeding time, and clotting time which were within normal limits, normal blood sugar, and viral screening including HIV, HBsAg, and HCV which were non-reactive or negative. Chest X-ray revealed normal findings with clear lung fields and no cardiopulmonary abnormalities.

An ultrasound of the scrotum demonstrated minimal right and moderate left hydrocele with left-sided epididymal simple cysts. Additionally, 2D echocardiography showed normal cardiac chamber sizes, good biventricular function, grade I diastolic dysfunction, and no significant structural abnormalities. 

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

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

The procedure involved the following steps:

• Patient Preparation and Anaesthesia: The patient was taken to the operating room and placed in a supine position. After standard aseptic preparation and draping of the scrotal and groin region, spinal anaesthesia was administered successfully, and adequate anaesthetic effect was confirmed before proceeding with surgery.

• Surgical Exposure: A scrotal incision was made on the left side, and dissection was carried through the scrotal layers to expose the tunica vaginalis sac containing the hydrocele fluid. Careful hemostasis was maintained throughout the dissection.

• Identification and Evacuation of Hydrocele Sac: The hydrocele sac was isolated and opened, revealing clear fluid with internal septations. The fluid was completely evacuated, and the sac was inspected. The underlying testis was found to be normal in appearance and consistency.

• Surgical Correction of Hydrocele Sac: The tunica vaginalis sac was everted (Jaboulay’s technique) and the edges were carefully sutured to prevent re-accumulation of fluid. Complete hemostasis was achieved to ensure no active bleeding within the operative field.

• Closure and Drain Placement: A corrugated rubber drain was placed in the scrotal cavity to prevent fluid collection postoperatively. The wound was then closed in layers, and the skin was approximated using absorbable sutures, and a sterile dressing was applied.
  

Postoperatively, the patient had an uneventful course with stable vital signs and no complications such as bleeding or infection. The surgical site remained healthy with satisfactory drain output. Intravenous medication was administered to prevent postoperative infection. He tolerated oral intake well, mobilized early, and was discharged in stable condition.

Upon discharge, the patient was advised to take a short course of oral antibiotics to prevent postoperative infection, pain relievers to control postoperative pain, and gastroprotective medication to prevent acidity and gastric discomfort. Additionally, he was prescribed medication to reduce postoperative swelling and inflammation, along with supportive supplements to promote wound healing and overall recovery.

The patient was advised to continue a normal diet as tolerated, with adequate hydration and balanced nutrition to support postoperative recovery and wound healing.

The patient was instructed to contact the emergency ward at PACE Hospitals in the event of an emergency or if symptoms such as fever, increasing scrotal pain or swelling, wound discharge, bleeding from the surgical site, or sudden onset of scrotal discomfort occur.

The patient was advised to return for follow-up with the Urologist in Hyderabad at PACE Hospitals after 3 days for dressing change and drain removal. He was also advised to review with the physician if blood pressure remains persistently elevated.

This case highlights a moderate left hydrocele with associated minimal right hydrocele and incidental left epididymal simple cysts presenting with scrotal pain. The patient underwent successful left hydrocelectomy under spinal anaesthesia, with an uneventful intraoperative and postoperative course. Preoperative evaluations were within acceptable limits, with no contraindications for surgery. The patient was discharged in stable condition with appropriate postoperative care and follow-up advice.