Abnormal collection of serous fluid in tunica vaginalis around the testis.
History taking
- • Painless scrotal swelling, gradually enlarging
- • Onset, prior trauma/infection (epididymo-orchitis, filariasis, TB)
- • Discomfort, heaviness; effect on activities
Examination
- • Scrotal swelling, can get above, fluctuant, transilluminant
- • Testis impalpable separately (vaginal hydrocele)
- • Examine other testis, regional LN
Red flags
- • Sudden onset with pain — exclude torsion, haematocele
- • Solid component on USG — exclude tumour
Differential diagnosis
- • Inguinal hernia, epididymal cyst, varicocele, testicular tumour, haematocele
Recommended investigations
- • USG scrotum (confirm fluid + assess testis)
- • Filaria card/serology in endemic areas
Diagnosis
- • Clinical + USG
Initial treatment / management
- • Small asymptomatic: observation
- • Symptomatic: surgery (Jaboulay/Lord plication) — definitive
- • Aspiration only if patient unfit for surgery (high recurrence)
Prescription examples
- • Post-op: scrotal support, Paracetamol, antibiotic only if indicated
- • Filarial hydrocele: DEC + Albendazole per protocol
Follow-up advice
- • Wound review 7 days; follow-up at 6 weeks
Patient counselling
- • Reassurance about benign nature
- • Scrotal support post-op
Referral criteria
- • All symptomatic hydroceles to surgery
- • Suspected malignancy — urgent referral
Clinical pearls
- • Always evaluate testis on USG to exclude underlying tumour
- • In endemic regions, consider filariasis as cause
References
- • Bailey & Love's Short Practice of Surgery 28e
Educational outpatient guide — verify against local guidelines before clinical use.
