Hydrocele

Disclaimer

These guidelines have been produced to guide clinical decision making for general practitioners (GPs). They are not strict protocols. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.

Acute scrotal pain, suspected strangulated inguinal hernia or suspected testicular torsion requires immediate referral to the Emergency Department.

If there is a suspected mass, refer to General Surgery department immediately and contact the on call General Surgical Registrar for advice (via PCH Switch on 6456 2222).

Introduction

A hydrocele is a non-tender, soft, fluctuant scrotal swelling commonly found in infants (congenital) although in may develop later (acquired). The mass will transilluminate when a light is shone behind due to the fluid contained within.

This collection of serous fluid within the tunica vaginalis is usually related to a patent processus vaginalis large enough to allow peritoneal fluid to drain into the scrotum but small enough to prevent hernia.

Most congenital hydroceles will resolve spontaneously within the first two years of life with the closure of the patent processus vaginalis. In many cases the processus vaginalis will remain patent throughout life with many never resulting in the development of a hydrocele.

Pre-referral investigations

No pre-referral investigations required
Imaging is not indicated

Pre-referral management

Provide reassurance most congenital hydroceles resolve by 2 years old, without intervention.

When to refer

Refer to the General Surgery Department if:

the hydrocele is still present after 2 years of age.
it is congenital or an acquired hydrocele
is causing pain or enlarging.

How to refer

Routine non-urgent referrals from a GP or a Consultant should go to the Central Referral Service
Routine non-urgent referrals from a nurse practitioner, non-medical referrers or private hospitals go to the PCH Referral Office
Urgent referrals (less than seven days) are made via the PCH Referral Office.

Essential information to include in your referral

Patient demographics including next of kin and contact details.
Details regarding hydrocele - approximate size, when first noticed, is it getting larger or causing pain.
Medical and surgical history.

Useful resources

Acute scrotal pain or swelling - Royal Children's Hospital clinical guideline
Hydrocele - Sydney Children's Hospital Network
Hydrocele repair (child) - HealthDirect

References

Smith NP, Kenny SE. Inguinal hernia and hydrocele. Surgery (Oxford). 2008;26(7):307-9.
HealthDirect. Hydrocele repair (child) [Website]. Australia: HealthDirect; 2020 [cited 2021 March]. Available from: https://www.healthdirect.gov.au/surgery/hydrocele-repair-child.
M H, MA M. Hydrocele [Internet]. StatPearls; 2021 [updated 07/01/2021; cited 2021 May]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559125/.
The Royal Children's Hospital Melbourne. Acute scrotal pain or swelling [Webpage]. Melbourne: The Royal Children's Hospital Melbourne 2020 [updated July 2020; cited 2021 March]. Available from: https://www.rch.org.au/clinicalguide/guideline_index/Acute_scrotal_pain_or_swelling/.
The Sydney Children's Hospital Network. Hydroceles [Webpage]. Sydney: The Sydney Children's Hospital Network; [cited 2021 MARCH]. Available from: https://www.schn.health.nsw.gov.au/fact-sheets/hydroceles.
Jobson M, Hall NJ. Current practice regarding timing of patent processus vaginalis ligation for idiopathic hydrocele in young boys: a survey of UK surgeons. Paediatric Surgery International. 2017;33(6):677-81.

Reviewer/Team:	Mr Parshotam Gera, HoD General Surgery	Last reviewed:	May 2021
		Review date:	May 2024
Endorsed by:	CPAC	Date:	May 2021

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