Hydrocele is common in male infants and is due to persistence of the processus vaginalis (PPV) allowing peritoneal fluid to enter the scrotum. In most boys, spontaneous closure of the PPV occurs and the hydrocele disappears.
If this has not occurred by the age of 2 years the chances of resolution become less although it can occur up to 4 years or even older.
Almost all hydroceles are asymptomatic. However, some older boys, with larger hydroceles may complain of discomfort or be self-aware of the swelling.
Ultrasound scan is NOT normally required.
Special Considerations
A hydrocele should be confined to the scrotum and it should be possible to palpate a normal spermatic cord above the scrotal neck. Occasionally a tense hydrocele may extend to the external inguinal ring and be difficult to differentiate from an inguinal hernia. If there is doubt, then it is best to refer in the same way as an inguinal hernia (Urgent if less than 3 months of age, routine if older) but if clearly a hydrocele then referral should only be made if still present at or beyond 3 years of age.
FM, LS, JB Sept 22
Who to refer:
- A child older than 3 years with a persisting simple hydrocele.
- A younger child in whom there is uncertainty whether there is a hydrocele or an inguinal hernia present.
Who not to refer:
Any child with a simple hydrocele who is younger than 3 years of age.
How to refer:
Referral is via SCI Gateway
Referral Priority
A simple hydrocele will be vetted as a routine referral.
Surgical Priority
Ligation of the PPV for hydrocele is a non-urgent procedure.
- Simple reassurance.
- Referral to paediatric surgery, after age 3 years, for discussion of surgical management.
- Ultrasound scan is NOT normally required.
