REMEDY : BNSSG referral pathways


Checked: 03-10-2018 by Rob.Adams 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. This policy is currently being reviewed and hopefully will be updated in early 2019.

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.

It is possible that the new policy will consider allowing  referrals in one of more of the following cases and if applying for individual funding then it may help if evidence of the following is provided (although please be aware that there is no guarantee of funding approval at this stage):

  • Where the hydrocele is significantly affecting the patients gait resulting in reduced mobility and all conservative methods have been exhausted, as documented in primary care records
  • Where the position/ size of the hydrocele is causing the patient to be unable to urinate without assistance
  • Where there is an ulceration or breakdown of the skin caused by the hydrocele.
  • Where the hydrocele is greater than 3 times larger than the contralateral hemiscrotum based on clinical examination.

In children over the age of 2yo the following would also be considered:

  • Where the hydrocele is greater than 3 times larger than contralateral hemiscrotum based on clinical examination


  • parents report regular symptoms [e.g. discomfort, pulling, scratching etc] for greater than 12 months





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.