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Hydrocele (paediatric)

Checked: 23-12-2022 by Rob Adams Next Review: 23-12-2023

Overview

Please see CKS guidelines on Scrotal Pain and Swelling.

Please also refer to the clinical guidance for Surgical Conditions - Management & Referral provided by Bristol Royal Hospital for Children.

A hydrocele is a collection of serous fluid between the layers of the membrane (tunica vaginalis) that surrounds the testis or along the spermatic cord. Rarely, similar fluid collection can occur in females along the canal of Nuck.

Common in male infants and the newborn. Most paediatric hydroceles are congenital and, in the majority of cases, resolve within the first year of life* (1)

*Local guidelines advise that spontaneous resolution occurs in children up to two years of age and children should not be considered for referral prior to this - see guidelines below.

Before Referral

Local Guidelines

Diagnosis of a hydrocele can usually be made by taking a history and clinical examination alone. Examination should check for presence of an inguinal hernia* and then the scrotum should be transilluminated to confirm the presence of fluid around the testicle.

(*Refer to a paediatric surgeon if an inguinal hernia is suspected.)

USS of the scrotum is not routinely required for diagnosis and requests for this purpose may be declined (See BRHC Paediatric radiology guidelines page.)

Reassure the parents that the hydrocele is likely to resolve by two years of age.

If there is still diagnostic uncertainty then a referral can be made to a paediatric general surgeon via eRS for an opinion only and should clearly state:

'I am referring this child for a clinical opinion as to whether they have a hydrocele. I am unable to request an ultrasound as it is not allowed. I have explained to the parents that surgery would not be offered as it is not funded and that this appointment is simply for a diagnostic opinion.'

Referral

If a hydrocele has not resolved by the age of 2 then surgical repair may be considered if criteria are met as laid out in the BNSSG ICB funding policy:

Hydroceles - Surgical Removal - under 16 years of age - NHS BNSSG ICB

i.e. The child has a hydrocele that is at least three times the length of the contralateral hemiscrotum based on clinical examination (Where there are bilateral hydroceles these should be considered against what the size would have been in normal anatomy)

AND

The hydrocele has been present at this size for a minimum of six months and this is clinically recorded within the patient’s primary care record.

If funding is approved, then referrals should be via eRS to paediatric general surgeons rather than urologists.

Please note that waiting time for referrals to paediatric surgeons and urologists are currently very long so please manage expectations of parents.

Resources

(1) Hydrocele - Symptoms, diagnosis and treatment | BMJ Best Practice

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