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Hydrocele

Checked: 23-11-2020 by Vicky Ryan Next Review: 23-11-2022

Overview

Please see link to CKS guidelines on Hydrocele.

Locally, referrals for hydrocele are not available routinely and require prior approval - see Hydroceles in Patients 16 years or over Policy. There is a separate policy for Hydroceles - Surgical Removal – under 16 years of age Policy.

Part 1 of the policy refers to measurement of the hydrocele to secure funding. Please measure lengthwise and not width as follows (diagram is not to scale):

Where there are bilateral hydroceles these should be considered against what the size would have been in normal anatomy.

Part 2 of this policy considers where the position / size of the hydrocele is causing the patient significant difficulties urinating. This is aimed to support where the hydrocele is either directly restricting the flow of urine or is directly causing incontinence. It is not to cover patients who need to sit or stand in different positions as this will be addressed by the size of the hydrocele.

The local urologists have advised against diagnostic aspiration (due to risk of spread of malignant cells) or therapeutic aspiration (due to risk of scarring which can make surgical intervention more complex) in primary care.

Referral - Prior Approval required

Please complete the Prior Approval application form found here. This form is also available as an EMIS template.

Red Flags

Investigations are not normally required for a simple hydrocele but are essential if there are any doubts in the diagnosis or any suggestion of an underlying cause. Failure to clearly delineate the testis, tenderness on palpation, or internal shadows on transillumination, are all indications for further investigation.

Consider whether the hydrocele may be due to an underlying cause, such as testicular torsion, testicular cancer, epididymo-orchitis, trauma or varicocele operation.
Admit, or refer appropriately depending on the underlying cause.
If the man is 20-40 years of age, or the testis cannot be palpated, arrange an urgent USS of the scrotum.

(From CKS)

A 2WW USS or urology referral should be considered if malignancy is suspected. Please see Urology 2WW section for details.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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