Shaping better health
REMEDY : BNSSG referral pathways


Checked: 15-01-2019 by vicky.ryan Next Review: 03-10-2019


Please see link to CKS guidelines on Hydrocele.

Locally referrals for hydrocele are not available routinely and require individual funding - see Hydroceles in Males INNF policy.

The local urologists have advised against diagnostic aspiration (due to risk of spread of malignant cells) or therapeutic aspiration (due to risk of scarring which can make surgical intervention more complex) in primary care.






If individual funding is approved then referrals must be made via eRS including recent BP and BMI.

Patients will be then be offered a choice of provider.

Red Flags

Investigations are not normally required for a simple hydrocele but are essential if there are any doubts in the diagnosis or any suggestion of an underlying cause. Failure to clearly delineate the testis, tenderness on palpation, or internal shadows on transillumination, are all indications for further investigation.

  • Consider whether the hydrocele may be due to an underlying cause, such as testicular torsion, testicular cancer, epididymo-orchitis, trauma or varicocele operation.
  • Admit, or refer appropriately depending on the underlying cause.
  • If the man is 20-40 years of age, or the testis cannot be palpated, arrange an urgent USS of the scrotum.

(From CKS)

A 2WW USS or urology referral should be considered if malignancy is suspected. Please see Urology 2WW section for details.