Hydrocele correction (including hydrocelectomy, ligation of patent processus vaginalis and sclerotherapy)

For the treatment of

Hydrocele

Commissioning position

These interventions are commissioned if:

there is suspicion of concomitant inguinal hernia or underlying testicular pathology
ultrasound indicates an abdominoscrotal hydrocele AND the hydrocele is symptomatic

the hydrocele is causing functional problems AND
has been monitored conservatively without spontaneous resolution:
- for at least 1 year in a child below the age of 3 years
- for at least 9 months in a child aged 3 years and older or an adult

Sclerotherapy is only commissioned for people aged over 16 years if:

the hydrocele is causing functional problems AND
has been monitored conservatively without spontaneous resolution for at least 9 months AND
there are contraindications to other surgical options.

Sclerotherapy is not commissioned for children under 16 years of age.

Summary of rationale

In most infants, observation is warranted at least within the first twelve months because of the tendency of spontaneous resolution, which decreases with age (92% resolution below one year old and 43% above three years). Initial observation poses little risk as progression to hernia is rare and does not result in incarceration. In acquired hydrocele, suggestive of a non-communicating hydrocele, there is still a reasonable chance of spontaneous resolution (75%) and expectant management of six to nine months is recommended. The rate of spontaneous resolution appears lower for an abdominoscrotal hydrocele. Suspicion of a concomitant inguinal hernia or underlying testicular pathology are indications for early surgery.

Sclerosing agents should not be used in children to treat hydroceles because of the risk of chemical peritonitis. However, sclerotherapy may be an option for adults with contraindications to other surgical options. Aspiration is not recommended because it is not curative, recurrence is likely, and the procedure carries risk of infection.