treatment. Hydroceles that persist after the first year or occur later in life require treatment only in selected cases, such as patients who are symptomatic with pain or a pressure sensation, or when the scrotal skin integrity is compromised from chronic irritation; the treatment of choice is surgery and the operation is conducted via an open access technique aiming to excise the hydrocele sac. Anesthesia is required for the operation; general anesthesia is of choice in children, while spinal anesthesia is usually sufficient in adults. Local infiltration anesthesia is not satisfactory because it cannot abolish abdominal pain due to traction on the spermatic cord. In longstanding cases, hydrocele fluid may be opalescent with cholesterol and may contain crystals of tyrosine. After aspiration of a primary hydrocele, fluid reaccumulates over the following months and periodic aspiration or operation is needed. For younger patients, operation is usually preferred. Sclerotherapy is an alternative; after aspiration, 6% aqueous phenol (10–20 ml) together with 1% lidocaine for analgesia can be injected, and this often inhibits reaccumulation. These alternative treatments are generally regarded as unsatisfactory because of the high incidence of recurrences and the frequent necessity for repetition of the procedure. References External links Urological conditions Gross pathology