What initial investigations should be performed in a patient presenting with a suspected hydrocele?

Initial investigations for a patient presenting with a suspected hydrocele include:

• Perform a clinical assessment to differentiate between congenital and non-congenital hydrocele, and to assess for any underlying causes such as testicular torsion, testicular cancer, epididymo-orchitis, trauma, or previous varicocele surgery.
• For patients aged 18–40 years or if the testis cannot be palpated, arrange an urgent ultrasound scan of the scrotum to exclude underlying testicular pathology, including cancer.
• If the hydrocele is congenital and the patient is under 12 months old, reassurance and watchful waiting are appropriate as most resolve spontaneously by 12 months of age.
• In cases of suspected trauma or haematocele, urgent ultrasound and possible hospital admission are indicated.
• Further investigations or specialist referrals depend on ultrasound findings and clinical suspicion of underlying causes.

These steps ensure appropriate diagnosis and management, including ruling out malignancy or other serious conditions.

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