A hydrocele is a collection of fluid around the testis, while a varicocele is a group of enlarged veins in the spermatic cord, usually on the left. Both cause painless scrotal swelling, and a varicocele can affect fertility and testicular growth.
Key symptoms
- Painless scrotal swelling or heaviness
- Hydrocele: smooth swelling that may change size in children
- Varicocele: dull ache that worsens with standing
- Varicocele: trouble conceiving in some men
What you find on exam
- Hydrocele: smooth, cystic swelling around the testis
- Varicocele: bag of worms above the testis, larger when standing and with Valsalva
- Compare testis size on both sides
- Check for an inguinal hernia
Tests
- Transillumination at the bedside: a hydrocele glows
- Scrotal ultrasound with Doppler to confirm and exclude a tumor
- Semen analysis for a varicocele with infertility
- Abdominal imaging for a right-sided varicocele or one that does not empty lying down
Treatment basics
- Infant hydrocele: observe, most resolve by 1 to 2 years
- Adult hydrocele: surgery (hydrocelectomy) if large or bothersome
- Varicocele: surgical repair or embolization for infertility, pain or a shrinking testis
- Scrotal support and NSAIDs for discomfort
Red flags
- Sudden severe pain (torsion)
- Solid testicular mass on ultrasound
- New right-sided varicocele or one that does not empty lying down
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.