Treatment of Hydrocele in Paris & Neuilly
Dr Adam Vardi - Urologist
Progressive enlargement of the scrotum
Treatment of hydrocele in Paris
A hydrocele is defined by an abnormal accumulation of serous fluid in the “vaginalis”, a small pouch surrounding the testicle within the scrotum. This benign condition results in a progressive increase in the volume of one or both sides of the scrotum, leading to physical discomfort, a feeling of heaviness or aesthetic concern.
Dr. Adam Vardi performs the differential diagnosis of this scrotal swelling and, when discomfort becomes significant, offers definitive surgical correction.
Pathophysiology and mechanisms of hydrocele formation
Urological Surgery in Paris & Neuilly
To understand hydrocele, it should be remembered that the testicle is normally surrounded by a protective membrane called the tunica vaginalis. Under normal conditions, a minimal amount of fluid allows the testicle to glide within the scrotum. A hydrocele appears when there is an imbalance between the production and reabsorption of this fluid.
Adult hydrocele (non-communicating)
In adults, hydrocele is most often “idiopathic” (with no identified cause). It results from the ageing of the membrane, which secretes too much fluid or no longer eliminates it sufficiently. It may also be secondary to:
- A testicular trauma.
- An infection (epididymitis or orchitis).
- Regional surgery (inguinal hernia repair or varicocele repair).
- Exceptionally, an underlying testicular tumor induces a fluid reaction.
Specialist of pediatric (communicating) hydrocele
Dr. Adam Vardi - Urologist in Paris & Neuilly
Unlike in adults, hydrocele in young children is due to the persistence of communication between the abdomen and the scrotum (peritoneo-vaginal duct). Peritoneal fluid then flows into the scrotum. This form often requires simple surveillance before the age of two, as spontaneous closure of the duct is frequent.
Symptoms and clinical diagnosis
Hydrocele primarily manifests as an increase in scrotal volume. This swelling is painless, distinguishing it from acute inflammatory processes. However, with increasing volume, a feeling of tension or heaviness may appear, hampering walking or dressing.
Treatment of hydrocele in Paris
Urologist in Paris
The physical examination
During the consultation, Dr. Vardi performs a thorough clinical examination. A characteristic sign is transillumination: by placing a light source against the scrotum in the dark, the fluid lets the light pass through, confirming the fluid (rather than solid) nature of the mass.
Scrotal ultrasound
Although the diagnosis is often clinically obvious, ultrasound is the systematic reference examination.
It allows:
- Confirmation of the presence of fluid around the testicle.
- Verification of the integrity of the underlying testicle (looking for a tumor or lesion).
- Exclusion of other conditions such as inguino-scrotal hernia or varicocele.
Therapeutic options: when should one operate?
As hydrocele is a benign condition, intervention is not systematic. It is indicated when the volume becomes uncomfortable, painful, or aesthetically problematic for the patient.
Aspiration: a temporary but discouraged solution
Needle aspiration drains the hydrocele immediately but is discouraged by urologists. The fluid always reforms within a few weeks, and the procedure carries a risk of infection (pyocele) or bleeding within the scrotum, complicating any subsequent surgery.
Surgical treatment: hydrocele repair
Surgery is the only definitive treatment. It is performed under general or spinal anesthesia, most often as ambulatory surgery.
The aim is to eliminate the fluid sac to prevent recurrence. The surgeon makes a short incision in the scrotum, evacuates the fluid, and treats the vaginalis membrane using two main techniques:
- Lord’s plication: the membrane is folded onto itself using sutures.
- Bergmann’s eversion: the membrane is turned behind the testicle so that fluid can no longer accumulate.
Postoperative course and convalescence
Recovery after hydrocele treatment is generally straightforward, but requires some precautions regarding the surgical site.
Postoperative swelling: It is common for the scrotum to remain swollen for a few days or weeks after the operation. This is not a recurrence but a normal inflammatory reaction of the tissues.
- Local care: The incision is closed with dissolvable sutures that fall out on their own in two to three weeks. Simple hygiene with soap and water is sufficient.
- Scrotal support: Wearing a jockstrap or tight-fitting underwear is strongly recommended for 10 to 15 days to limit testicular movement and reduce swelling.
- Sexual and physical activity rest: A break from sports and sexual activity is advised for about 3 weeks to allow for solid internal healing.
Conclusion
Hydrocele is a common condition with well-established treatment protocols. Although benign, it should not be ignored, particularly to ensure there are no associated testicular conditions. Modern surgical techniques offer permanent results with a very high patient satisfaction rate. Dr. Vardi prioritizes a transparent approach, explaining the benefits of the procedure in relation to the discomfort experienced, to ensure recovery under the best possible conditions.