Aim: To study the clinical treatment of cystic swelling of scrotum. Material and methods: This prospective observational study was conducted in the Department of Surgery at Patna Medical College Hospital, Patna from august 2023 to march 2024. The study included patients up to 75 years old with cystic swellings originating from the testis, its coverings, the epididymis, the spermatic cord, and the scrotal skin. Following approval by the Institutional Ethical Committee, 250 patients aged up to 75 years were enrolled in the clinical study, with written informed consent obtained from each participant.The patients admitted presented symptoms such as swelling, pain, and discomfort in the scrotal region. Blood investigations were conducted to rule out conditions like eosinophilia, microfilaria, lymphocytosis, and elevated ESR. Urine examinations were also carried out to identify any urinary tract infections. Scrotal ultrasound was performed on all patients to detect any changes in the testis and other scrotal structures. Results: During the clinical examination, 80% of the patients exhibited fluctuation in the swelling, and 72% showed translucency. All patients underwent examination of the testis, epididymis, and spermatic cord, with 12% having palpable regional lymph nodes. The majority of the patients (88%) underwent drain placement during surgery, with only 12% not requiring drains. The intraoperative findings showed that 60% of the fluid was clear, 24% bloody, and 16% purulent. Testicular changes were observed in 20% of the cases, while 28% had conditions affecting the epididymis. Postoperative complications were recorded in 42% of the patients, with fever in 8%, scrotal edema in 16%, hematoma in 12%, and infection in 6%. The majority of the patients (58%) experienced no complications, indicating generally favorable surgical outcomes but also highlighting areas for potential improvement in postoperative care to minimize complications. Follow-up outcomes showed that all patients attended the 1-month follow-up, with 92% attending the 3-month and 80% attending the 6-month follow-up. Complete recovery was observed in 88% of the patients, while 12% had ongoing issues. Conclusion: A cystic swelling of the scrotum poses a common surgical problem. Primary vaginal hydrocoele was the commonest cystic swellings of scrotum. Most of the cystic swellings were treated surgically with good results. Lord’s procedure was the least to have post-operative complication.