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What is the right treatment for enlarged hydrocoele?

Q: I am a 40 years old kidney patient and had a transplant 6 years ago. I met with an accident 2 years back and suffered form hemiparesis. I developed a hydrocoele after my transplant surgery. At that time the scrotum size was small. Now it is big (size of a lemon). I wish to remove it. Can it be removed by surgery or by laparoscopy? Will it be painful and can I resume my daily routine soon after the surgery? Will it recur after the surgery? I request you to clear my doubts on this and tell me how does it occur?

A:Enlargement of the scrotum on the side of transplantation is not uncommon due to collection of fluid around the testis in a sac called tunica vaginalis. There is always fluid being secreted and getting absorbed from this sac. Fluid accumulation occurs at any time when the fluid being secreted is more than the amount being absorbed. This may occur due to blockade of lymphatics in a disease like filariasis, and even in absence of a specific disease in situations like transplant when the lymphatics get choked after dissection and ligation around the blood vessels. Small hydrocoeles may not require any treatment. Larger collections causing discomfort while walking or sitting, or due to cosmetic reasons, need to be treated. Treatment is only surgical and is performed by creating a window in the outer layer of tunica to allow the secreted fluid to seep outside the tunica sac into a different plane from where the absorption is not a problem. Procedure is usually done under local anaesthesia and as a day procedure. You should be able to go home the same evening. Some discomfort may remain for a day or two. You would be able to resume work after this period. Suture used during surgery are self- dissolving and come off in 2 to 3 weeks time. Recurrences after the surgery are rare but may occur in multiloculated hydrocoeles.

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