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Hydrocele Workup

  • Author: Steven L Lee, MD; Chief Editor: Edward David Kim, MD, FACS  more...
Updated: Dec 08, 2015

Laboratory Studies

Few laboratory tests, if any, are warranted specifically for simple hydroceles, communicating or noncommunicating. Concomitant medical conditions may be indications for preoperative laboratory studies. Laboratory studies may be indicated to exclude other surgical or medical conditions that may be in the differential diagnosis.

Inguinal hernia

While laboratory studies are not warranted in routine inguinal herniorrhaphy, a possible incarcerated inguinal hernia may be difficult to distinguish from a hydrocele.

Failure to clearly transilluminate, palpable bowel at the internal ring during the rectal examination, or an elevated white blood cell count may favor urgent exploration in this setting.

Testicular tumor

Approximately 10% of patients with testicular teratomas may present with a cystic mass that may transilluminate during the physical examination. Similarly, adults with testicular tumors may present with newly onset scrotal swelling. If this diagnosis is considered, measuring serum alpha-fetoprotein and human choriogonadotropin levels is indicated to exclude malignant teratomas or other germ cell tumors.


Occasionally, a reactive hydrocele occurs in association with underlying testicular infection. Urinalysis and urine culture may beneficial. Although urinalysis and/or culture results are positive in only 30% of such cases, a positive culture result may be useful in guiding antimicrobial treatment. Symptoms are treated with nonsteroidal anti-inflammatory drugs and scrotal elevation.


Imaging Studies

The radiographic evaluation of hydroceles is controversial. Communicating hydroceles in patients (infants in particular) with a classic presentation and palpable testicle do not require radiographic studies. However, findings from radiographic or ultrasonographic studies can help evaluate for other underlying processes, such as a tumor or torsion, and can be useful in the setting of a non-communicating hydrocele or inability to palpate the testicle, acute onset of swelling/pain, or other atypical findings on presentation or examination.


Ultrasonography provides excellent detail of the testicular parenchyma. Spermatoceles can be clearly distinguished from hydroceles on sonograms. If a testicular tumor is a diagnostic consideration, ultrasonography is an excellent screening study.

In addition, testicular atrophy suggesting chronic torsion and a reactive hydrocele can be seen on sonograms. Failure to clearly delineate testicular anatomy with palpation indicates the need for further diagnostic imaging such as ultrasonography.

Duplex ultrasonography

Duplex studies may provide substantial information regarding testicular blood flow when a hydrocele may be associated with chronic torsion.

Additionally, epididymitis associated with a reactive hydrocele can be distinguished based on findings from duplex scanning, as evidenced by increased epididymal flow.

Finally, duplex studies may help identify Valsalva-augmented regurgitant flow in patients with varicoceles.

Plain abdominal radiography

Plain radiography may be useful for distinguishing an acute hydrocele from an incarcerated hernia. Gas overlying the groin may indicate an incarcerated hernia.


Histologic Findings

If a hernia is identified along with the hydrocele, the sac may be removed following high ligation and sent for pathological analysis. In this case, the histology findings are consistent with peritoneal lining.[7]

Contributor Information and Disclosures

Steven L Lee, MD Chief of Pediatric Surgery, Harbor-UCLA Medical Center; Associate Clinical Professor of Surgery and Pediatrics; University of California, Los Angeles, David Geffen School of Medicine

Steven L Lee, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, Association for Academic Surgery, Society of Laparoendoscopic Surgeons, International Pediatric Endosurgery Group, Pacific Association of Pediatric Surgery, Society of American Gastrointestinal and Endoscopic Surgeons

Disclosure: Nothing to disclose.


Jeffrey J Du Bois, MD Chief of Children's Surgical Services, Division of Pediatric Surgery, Kaiser Permanente, Women and Children's Center, Roseville Medical Center

Jeffrey J Du Bois, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, California Medical Association

Disclosure: Nothing to disclose.

Shant Shekherdimian, MD, MPH Resident Physician, Department of Pediatric Surgery, Hospital for Sick Children; Toronto, Ontario, Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Mark Jeffrey Noble, MD Consulting Staff, Urologic Institute, Cleveland Clinic Foundation

Mark Jeffrey Noble, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Kansas Medical Society, Sigma Xi, Society of University Urologists, SWOG

Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, Tennessee Medical Association, Sexual Medicine Society of North America, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Repros.

Additional Contributors

Edmund S Sabanegh, Jr, MD Chairman, Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation

Edmund S Sabanegh, Jr, MD is a member of the following medical societies: American Medical Association, American Society of Andrology, Society of Reproductive Surgeons, Society for the Study of Male Reproduction, American Society for Reproductive Medicine, American Urological Association, SWOG

Disclosure: Nothing to disclose.

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Hydrocele that extended retrograde into the abdominal compartment.
Hydrocele. Small patent processus vaginalis (indicated by the bubbles) as viewed laparoscopically.
Young girl with groin bulge, which, at surgery, was a hydrocele of along the canal of Nuck.
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