Key facts
- Hydrocele is a collection of serous fluid between the layers of the membrane (tunica vaginalis) that surrounds the testis or along the spermatic cord.
- Principally patients complain of scrotal swelling and fullness
- Divided into congenital and non-congenital hydrocele
History taking
- Look for risk factors
- Premature and low birth weight
- Infants <6 months of age
- Infants whose testes descend relatively late
- Increased intraperitoneal fluid or pressure
- Testicular cancer
- Connective tissue disorder
- Enlargement of scrotal mass following activity
- Variation in scrotal mass during the day
Examination
- Non-tender
- Easily transilluminated
- Cremasteric reflect preserved
- Often be able to get above it
Investigations
- Usually clinical diagnosis
- US if ?secondary cause
Differential diagnosis
- Inguinal hernia
- Testicular cancer
- Epididymitis
- Epididymo-orchitis
- Scrotal oedema
Management
- Congenital hydrocele
- Repair if does not resolve by 2 years
- Adolescent: surgery and/or aspiration
- Non-congenital
- USS to look for secondary cause
- Reassurance and scrotal support if asymptomatic