Hydrocele

Referrals pathways for Regional Paediatric model

Index:

Diagnosis

Practice points

Management

Referral pathways

A hydrocele is a common finding of fluid in the scrotum around the testis. It is generally self-resolving and requires no active management.

It is important not to confuse a hydrocele with an acute scrotal swelling - see the Royal Children's Hospital clinical practice guidelines.

Diagnosis

A hydrocele is a clinical diagnosis of a non-compressible transilluminable swelling around the testis, which may be present at or after birth and can be unilateral or bilateral.

It is important to distinguish a hydrocele from an inguinal hernia, with the latter being reducible (unless incarcerated) and compressible. You are not generally able to get above an inguinal hernia with palpation. Note that a hydrocele may sometimes be very slowly compressible, although never rapidly compressible.

Practice points

• Hydroceles are common non-compressible swellings that generally require no management prior to the age of 12 months
• Be aware that in male infants transillumination may be misleading given the ease of which light travels through normal genital structures at this age

Management

No active management is generally required for a hydrocele. Consider referral if very large, rapidly growing or not resolving after 2 years of age.

Referral pathways

• Paediatrician
  • Not generally required.

• Surgeon/urologist
  • Referral to a paediatric surgeon or urologist is recommended only if a hydrocele is very large, rapidly growing or not resolving after 2 years of age.