What initial investigations should be performed in a patient presentin

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

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.

References:

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