Laser Surgery for Hydrocele: Meaning, Purpose, Risks, Benefits

Laser hydrocele surgery is an advanced surgical procedure done to drain a hydrocele with the help of a laser beam. This procedure is also known as laser hydrocelectomy. 

Anatomy and Physiology of the Testis

Testis or testicles are two oval egg-shaped sex organs that play a vital role in the male reproductive system. They are around 4 to 5 cm in length and 2 to 3 cm wide and increase in size through adulthood and gradually decrease later in life due to a natural decline in testosterone (male hormone). They are present outside the body in a pouch called the scrotum. Their location outside the abdomen ensures optimum temperature and environment for the sperm cells to develop.

Within the scrotum, the testis is suspended from the abdomen by a collection of blood vessels, nerves, and ducts, known as the spermatic cord. This cord supports the health and function of the tests. 

The testis is made up of several lobes that contain a network of narrow tubes called seminiferous tubules. These tubules produce sperm by a process known as spermatogenesis. Further, these sperms pass to a tightly coiled tube on each testicle called the epididymis. This is where the sperm cells are stored and get completely mature. 

The two primary functions of tests are as follows:

1. Production of testosterone – a male sex hormone.
2. Production of sperm or spermatogenesis – a carrier of man’s genes.

There is no drug to treat hydrocele, although pain medication administration can help prevent any discomfort. Laser hydrocele surgery is generally recommended for treating hydrocele when it becomes complicated or symptomatic. This surgery can be performed for any kind of hydrocele including communicating and non-communicating hydrocele.

Laser hydrocele surgery is done to either repair or drains a hydrocele. 

1. Hydroceles most commonly develop in newborn babies but can also occur at any age; adult men or old boys can develop hydroceles due to an injury, inflammation or infection within the scrotum. 
2. Hydrocele is drained as it may be associated with testicular cancer.
3. Hydroceles can lead to infections in the area.

Laser hydrocele surgery is an outpatient and minimally invasive procedure. It takes less than 30 minutes to complete. This procedure is performed under anaesthesia (medication used to reduce the sensation in a specific part of the body) by a specialized team of anaesthetists, urologist, and other medical staff. For this procedure, the urologist and nurse will:

1. Make the patient lie down comfortably in a certain position.
2. Examine any tenderness or hernia.
3. Administer the IV line and anaesthesia.
4. Monitor the vitals of the patients.
5. Clean the scrotum area with an antiseptic solution.
6. Make a small incision using the laser beam on the scrotum to drain the collected fluid.
7. Reverse or remove the sac to seal it and prevent the occurrence of the hydrocele.
8. Dress the incision site with the help of bandage and drainage tubes will also be attached.
9. Shift the patient to a recovery room to monitor vitals and post-operative recovery.

Before the laser hydrocele surgery, the doctor/surgeon will discuss and prepare the patient for the surgery. These steps often involve:

Before Laser Hydrocele Surgery

1. The doctor will brief the patient regarding the procedure and its risks.
2. The patient will also be asked to get some blood tests done to check for the patient's medical condition.
3. The patient should discuss the health conditions like when he observed the swelling or if there was any unusual discharge from the penis.
4. Based on the tests and medical observations, the doctor can finalise the type of anaesthesia for the patient.
5. The patient should discuss any allergies with the doctor.
6. While taking instructions from the doctor, the patient should ensure that he has discussed his full medical history, including any supplements or medications he takes.
7. The doctor may also ask the patient to stop taking some medications a week before the surgery.
8. The patient should avoid eating solid food at least 6 hours before the surgery.

On the day of Laser Hydrocele Surgery

1. The patient needs to reach the hospital before the scheduled time.
2. The patient will be asked to sign the consent form in the presence of his/her family.
3. The patient will be instructed to remove his street clothes and jewellery and wear a hospital gown or shorts.
4. A nurse will place an intravenous catheter in the patient’s hand or forearm and inject a mild sedative.
5. Vitals will be monitored.
6. The patient will then be shifted to the operation theatre.

Usually, the procedure doesn’t take my time to complete. The patient will then be moved to the hospital ward to check for the recovery process and vitals. 

The recovery process at the hospital

1. The patient may be administered local anaesthesia to minimise post-operative pain, and an ice pack will also be advised.
2. The patient may experience mild, painless swelling after the laser procedure, which vanishes within a day or two. 
3. The doctor will prescribe antibiotics and medications for pain relief.
4. The patient will be discharged after almost 6 hours of surgery.
5. The patient should make sure that someone is available to pick him up after discharge as he won’t be allowed to drive home by themselves.

Recovery process/expectation after hospital discharge

1. For better recovery, the patient will be advised to wear a scrotal support for 3 to 5 days post-surgery.
2. The patient will need fluid drainage tubes for 5 to 6 days.
3. The patient should avoid doing heavy lifting or strenuous exercise.
4. The patient will also be advised to avoid sexual intercourse for 3 to 4 weeks.
5. The patient should wear loose clothing for ease and comfort.

First follow-up appointment

The doctor will advise the patient to consult for the first follow-up. It is usually within 2 to 4 days. 

1. The doctor checks the recovery of the incision.
2. The doctor will check the incision and change the dressing from the incision site.
3. The doctor might also change the medication or advise the patient to continue with the previous medication for some more time, depending on the condition and recovery of the surgical area. 
4. The doctor will advise the patient for further timely follow-ups as well.

Laser hydrocele surgery is a minimally invasive procedure as it occurs through small incisions. Other benefits of laser hydrocele surgery include:

1. The possibility of blood loss is very less.
2. The pain is inexistent.
3. Low risk of recurrence.
4. The patient can go home in 6 hours.
5. Can expect quicker and better recovery.
6. Fewer chances of infection and blood clots.

Laser hydrocele surgery is a relatively safe procedure, but it is a surgical procedure, and just like any other surgical procedure, laser hydrocele surgery has few complications associated with it. The risks and complications of arthroscopy include:

1. Anaesthesia risks.
2. Healing problems.
3. Infection.
4. Mass of clotted blood (hematoma).
5. Swelling.
6. Bruising.
7. Unfavourable scarring.
8. Recurrence.

When is consultation with the doctor needed?

The patient can consult the doctor if the patient experiences any abnormal symptoms including:

1. Heavy bleeding
2. Fever of 100 degree 
3. Infection
4. Increased pain and swelling

If the hydrocele is not treated promptly, it can threaten the patient's life. The common risks of delayed laser hydrocele surgery include:

1. Increase in size
2. Severe pain
3. Infection or tumour
4. Block the blood supply to the testes
5. Threaten overall functioning of other structures present in the scrotum
6. Inguinal Hernia
7. Orchitis and Epididymitis
8. Atrophy of testis

The cost of laser hydrocele surgery ranges from ₹20,000 to ₹90,000. The cost of the surgery varies based on the following factors:

1. Age of the patient
2. Technique & equipment used
3. The medical condition of the patient
4. The type of hospital facility availed - individual room or shared.