Snapshot A 6-year-old boy presents to the pediatrician’s office for a well-child visit. He has no complaints and enjoys going to school. He is tracking along well on his weight and height chart at the 60% percentile. His parents have no concerns. On physical exam, the physician notices a tense and non-tender mass in the scrotum. The mass transilluminates when light is shone through it. His physician recommends waiting 6 months before deciding whether or not to proceed with a surgical correction. Introduction Clinical definition swelling in scrotum due to fluid accumulation between parietal and visceral layers of tunica vaginalis communicating hydroceles incomplete closure of processus vaginalis account for most cases of hydroceles in infants and children non-communicating hydroceles complete closure of processus vaginalis most often idiopathic account for all cases of adult hydroceles Epidemiology incidence 1% of adult men 1-4.7% of male infants Etiology adults and adolescents trauma infection acute epididymitis mumps tumor mesothelioma 10% of testicular tumors present with hydrocele infants and children (congenital) incomplete obliteration of processus vaginalis Prognosis natural history of disease congenital hydrocele usually resolves spontaneously by 1 year of age Presentation Symptoms painless bulge of genitals Physical exam scrotum nontender tense fluid-filled enlarged scrotum transilluminates positive transillumination test Imaging Ultrasound indications only if diagnosis is uncertain or suspicion for tumor Differential Varicocele “bag of worms” Treatment Conservative monitoring indications monitor for 6-9 months for small noncommunicating hydrocele in adults monitor until after 1 year of age for communicating hydrocele in infants Operative surgical hydrocelectomy indication if hydrocele does not self-resolve during monitoring (see above) Non-operative aspiration and sclerotherapy indications for patients wanting a less invasive option Complications Testicular damage Subfertility