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  • 1. Right Incision
  • 2. Entry into Sac and Primary Drainage
  • 3. Mobilize and Externalize Sac
  • 4. Excise Sac
  • 5. Right Closure
  • 6. Left Incision
  • 7. Entry into Contralateral Sac and Primary Drainage
  • 8. Mobilize and Externalize Sac
  • 9. Excise Sac
  • 10. Left Closure
  • 11. Removal of Subdermal Implants
  • 12. Post-Op Remarks
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Bilateral Simple Hydrocelectomy and Removal of Subdermal Implants


Domingo Alvear, MD1; Lissa Henson, MD2; Jaymie Ang Henry, MD, MPH3

1World Surgical Foundation
2Philippine Society of Pediatric Surgeons
3Florida Atlantic University, G4 Alliance

Main Text


A hydrocele is a collection of fluid within the membranes surrounding the testicle, which causes swelling of the scrotum. It is often caused by fluid secreted from a remnant piece of peritoneum wrapped around the testicle called the tunica vaginalis. Other causes include defective absorption of fluid, interference with lymphatic drainage, and a connection to the peritoneal cavity with a hernia. It occurs in around 5% of newborns and usually disappears without treatment by the age of 1. They may also occur in older boys and adult men, often due to infection, inflammation, or testicular injury. A hydrocele can be unilateral or bilateral, and most commonly occur on the right. It presents with painless scrotal swelling that fluctuates in size, bluish discolouration of the skin, and a feeling of discomfort and heaviness if the hydrocele is large. A transillumination test is done to differentiate hydrocele from other causes of scrotal swelling. With a hydrocele, the presence of fluid will cause the scrotum to light up when a light is shone on the area. Ultrasonography may be recommended for adult men to rule out conditions such as testicular torsion or tumor. A hydrocele can be treated by draining the fluid with a needle or by open surgical procedure. Surgical removal of a hydrocele (hydrocelectomy) is often the method of choice and is recommended in cases where the hydrocele is large and painful or has recurred after aspiration. Here, we present the case of an adult male who was diagnosed with bilateral hydroceles via ultrasound following a positive transillumination test. After an incision was made, the hydrocele was isolated and removed. This was followed by replacement of the testis within the scrotum. Subdermal implants were also removed from the penile shaft.

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