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Hydrocele in Emergency Medicine Treatment & Management

  • Author: Scott E Rudkin, MD, MBA; Chief Editor: Erik D Schraga, MD  more...
Updated: Mar 23, 2016

Emergency Department Care

Differentiating between a hydrocele and an acute scrotum (eg, testicular torsion, strangulated hernia) is important.[10]

As many as 50% of acute scrotum cases are initially misdiagnosed.

Transillumination is not diagnostic and cannot rule out an acute scrotum.

Ultrasound anatomic imaging with Doppler evaluation of testicular blood flow is indicated when an acute scrotum is suspected, as follows:

  • A traumatic hemorrhage into a hydrocele or testes
  • A testicular torsion with or without a secondary hydrocele
  • An ischemic testicle

In children, hydrocele is treated through inguinal incisions with high ligation of the patent processus vaginalis and excision of the distal sac.[10]



Immediately consult a urologist if testicular torsion is found or suspected. A urologic follow-up examination is required if any testicular pathology is involved. A general surgery evaluation is indicated for patients with a tense hydrocele that threatens to embarrass scrotal circulation. Surgical evaluation is also indicated for hydrocele producing a large and bulky mass that is unsightly or uncomfortable.


Medical Care

Surgical removal of hydroceles is the gold standard of care. However, high success rates (85-96%) have been reported with a combination of aspiration and sclerotherapy. Reports of effective agents include polidcocanol, phenol, tetracycline ethanolamine oleate, sodium tetradecyl sulfate (STS), and alcohol. Complication rates have been reported to be as high as 50%.[11, 12, 13, 14, 15, 16]

Contributor Information and Disclosures

Scott E Rudkin, MD, MBA RDMS, FAAEM, FACEP, Clinical Professor, Department of Emergency Medicine, Associate Chief Medical Information Officer, University of California at Irvine Medical Center

Scott E Rudkin, MD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.


A Antoine Kazzi, MD Deputy Chief of Staff, American University of Beirut Medical Center; Associate Professor, Department of Emergency Medicine, American University of Beirut, Lebanon

A Antoine Kazzi, MD is a member of the following medical societies: American Academy of Emergency Medicine

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.

Richard H Sinert, DO Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Vice-Chair in Charge of Research, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Additional Contributors

Edward A Michelson, MD Associate Professor, Program Director, Department of Emergency Medicine, University Hospital Health Systems of Cleveland

Edward A Michelson, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.


The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Mazen J El-Sayed, MD, to the development and writing of this article.

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