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A hydrocele of the tunica vaginalis occurring within the first year of life seldom requires operation, since it will often disappear without treatment. Hydroceles that persist after the first year or appear later in life usually require treatment, since they show little tendency toward spontaneous regression. All symptomatic hydroceles in adults or in children older than 2 years should be removed. Most hydroceles are painless, and symptoms arise only from the inconvenience caused by their size or weight. The long-continued presence of a hydrocele infrequently causes atrophy of the testicle. Open operation is the method of choice for removing the hydrocele. Aspiration of the hydrocele contents and injection with sclerosing agents are generally regarded as unsatisfactory treatment because of the high incidence of recurrences and the frequent necessity for repetition of the procedure. Occasionally, severe infection can be introduced by aspiration. Simple aspiration, however, often may be used as a temporary measure in those cases where surgery is contraindicated or must be postponed.
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The accuracy of the diagnosis must be ascertained. Great care must be taken to differentiate a hydrocele from a scrotal hernia or tumor of the testicle. Ultrasound imaging can be very useful in these cases. A hernia usually can be reduced, transmits a cough impulse, and is not translucent. A hydrocele cannot be reduced into the inguinal canal and gives no impulse on coughing unless a hernia is also present. In young children, a hydrocele is often associated with a complete congenital type of hernial sac.
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Either spinal or general ...