Transillumination is not diagnostic and cannot rule out an acute scrotum. Urologic follow-up must be insured if any testicular pathology is involved. A general surgery evaluation is indicated for patients with a tense hydrocele that threatens to embarrass the scrotal circulation. Surgical evaluation is also indicated for hydrocele producing a large and bulky mass that is unsightly or uncomfortable. In children, hydrocele is treated through inguinal incisions with high ligation of the patent processus vaginalis and excision of the distal sac.
Spontaneous closure is unlikely beyond one year of age.
Observe infants with hydrocele for 1-2 years or until definite communication is demonstrated. Watch for a concomitant hernia. The resulting ischemia can cause testicular atrophy and subsequent impairment of fertility. Hemorrhage into the hydrocele can result from testicular trauma. Incarceration or strangulation of an associated hernia Surgical Complications Accidental injury to the vas deferens can occur during inguinal surgery for hydrocele.