Treatment

Hydrocoeles that present in early childhood are managed as a patent processus vaginalis with operation indicated only if they persist after the first year. The procedure is as for an inguinal hernia - open the sac, inspect the testis for abnormalities, ligate and divide the patent processus.

In adults, primary hydrocoeles may be treated:

• conservatively - reassure the patient and provide a scrotal support.
  
  
• by aspiration - use a sterile needle and syringe. Clear, pale yellow fluid should be drained; fluid that is bloodstained suggests trauma or other underlying pathology. Following aspiration, the testis should be palpable. A sclerosant such as phenol may then be injected to stop fluid from reaccumulating, otherwise, periodic aspiration may be necessary. A hydrocoele should not be tapped if there is any suspicion of tumour - in the case of a tumour, aspiration may result in spread of malignant cells.
  
  
• by operation - if the diagnosis is in doubt, the hydrocoele is large, or fluid repeatedly reaccumulates after drainage. Once the fluid has been removed, the testis is examined for abnormalities.

In secondary hydrocoeles, treatment is of the underlying condition.