How can I effectively counsel patients regarding the prognosis and management options for hydrocele?

Effective counselling for patients with hydrocele involves providing clear information on prognosis and management options tailored to age and clinical presentation.

For infants with a suspected congenital hydrocele, reassure parents that most hydroceles resolve spontaneously by 12 months of age without treatment, so watchful waiting is appropriate during this period.

If the hydrocele persists beyond 12 months, is associated with an inguinal hernia, testicular pathology, or is localized to the spermatic cord, referral to a paediatric surgeon should be arranged based on clinical judgement.

For adolescents and adults with a suspected non-congenital hydrocele, assess for underlying causes such as testicular torsion, cancer, epididymo-orchitis, trauma, or prior surgery.

Urgent ultrasound and specialist referral are indicated if the patient is aged 18–40 years or if the testis cannot be palpated to exclude malignancy.

If no underlying cause is found and the hydrocele is idiopathic and asymptomatic, reassure the patient and advise on self-management measures such as scrotal support.

For large or symptomatic hydroceles, referral to a urologist or paediatric surgeon is appropriate to discuss surgical options.

Surgical hydrocelectomy is the standard treatment for symptomatic hydroceles, while aspiration and sclerotherapy may be considered for patients unfit for surgery but have lower success rates.