Objective: To evaluate the treatment of hydrocele and compare the post-operative course and outcome of sodium tetradecyl sulfate (3 %) (STDS) as a harmless and active sclerosant followed by aspiration with conventional hydrocelectomy for the management of adult hydrocele. Study Design: Cross Sectional, Randomized study. Setting: Liaquat University of Medical and Health Sciences, Jamshoro. Period: 1st May 2019 to 31st October 2019. Material & Methods: Fifty patients with unilateral or bilateral primary vaginal hydrocele were included in this study. Subjects with secondary vaginal hydrocele (secondary to trauma, malignancy, or epididymo-orchitis), communicating hydrocele, infected hydrocele, having a positive history of previous intervention (sclerotherapy or operation) and/or uncontrolled diabetes mellitus were excluded. Data were analyzed in SPSS version 22.0. Results: All patients were equally divided into two groups A and B. Group A (n = 25) patients were submitted to Sclerotherapy and Group B (n = 25) patients were submitted to the Conventional Surgical Hydrocelectomy. Most of the patients 24(96.0%) who underwent in Group A (Sclerotherapy, n = 25), were discharged within 1-6 days i.e. less postoperative stay whereas the majority of the patients 14(56.0%) who underwent in Hydrocelectomy group were discharged between 1 to 6 days. Patients who underwent Hydrocelectomy had more postoperative stay and in 3 cases up to 18 days. Conclusion: Sclerotherapy is the treatment of choice for primary hydrocele. Complications like pain, hematoma, and infection are less than surgical procedures. Hospital stay is minimal and does not affect the day-to-day work of the patient having sclerotherapy.