Hydrocele

Meet the patient

A 54-year-old man comes to the surgical outpatient clinic because, over six months, his left scrotum has slowly enlarged. It does not hurt, he is systemically well, and he is here only because his wife noticed it. The swelling is soft and fluctuant, transilluminates to a red glow, and — crucially — you can slide two fingers above its upper limit. He cannot feel his testis separately through the fluid.[2]

Two questions decide his next hour, and they decide every hydrocele stem you will ever face: is the swelling confined to the scrotum, or does it reach the groin? (the can-get-above sign answers that at the bedside) and is a tumour hiding behind the fluid? (only the ultrasound answers that). Hold those two questions and the whole topic slots into place.[1]

The sac that explains everything — anatomy and the name

The tunica vaginalis is a double-layered serous sac, and what happens to it during development decides every subtype of hydrocele. The visceral layer hugs the testis and epididymis; the parietal layer lines the scrotal wall; a few millilitres of lubricating fluid sit between them. A hydrocele is simply that fluid accumulated in excess.[1]

Etymology for viva gold: hydro is Greek for water, kele for hernia or tumour — so a hydrocele is literally a "water hernia". The name is older than our embryology, yet it still names the disease exactly: a sac of water in the scrotum. Forgotten etymology, not forgotten meaning.[1]

The clinical importance of a hydrocele is never the diagnosis itself — that is bedside and straightforward — but the discipline of excluding the dangerous things it mimics. A testicular tumour can sit behind a reactive hydrocele; an incarcerated hernia can be mislabelled as one; a tense hydrocele can bury a malignancy you cannot feel. It is the commonest cause of painless scrotal swelling across all ages, and the aetiology splits cleanly by age: congenital (patent processus) in infants, primary or secondary in adults, filarial in the tropics.[4][6]

The can-get-above sign — one move that separates hydrocele from hernia

If your fingers can palpate above the upper limit of a scrotal swelling, it is a hydrocele; if they cannot, it is an inguinal hernia. Bring both index fingers to meet over the swelling: if they close above it, the lesion is confined to the scrotum; if the swelling runs up into the inguinal canal, it is a hernia. This is the single most reproduced discriminator in the scrotal-swelling viva.[2]

[1]

The four bedside signs — Get-above, Transillumination, Cough impulse, Testis-buried

Four signs at the bedside, and they confirm a vaginal hydrocele while excluding its mimics. Examine the patient standing first (to reveal a varicocele and to test the cough impulse) then lying down (to test reducibility and re-palpate).[2][1]

[1]

The four named signs, in the order you elicit them:[2][1]

• Can get above the swelling — the pivotal question. Yes equals scrotal; no equals inguinal hernia.
• Transillumination positive — darken the room, place a pen-torch flat against the posterior aspect of the swelling; a clear hydrocele gives a homogeneous red glow. A chylocele or haematocele transilluminates poorly.[1]
• Cough impulse absent — the vaginal sac is closed. A communicating hydrocele or a hernia gives a palpable expansile impulse, because the peritoneal connection transmits raised intra-abdominal pressure.
• Testis buried — you cannot feel the testis separately in a vaginal hydrocele; it lies posteriorly within the fluid. In a hernia the testis sits in its normal position, separate from the swelling.[1]

The classic trap: a fluid-filled hernia (rare) can transilluminate, and a tense hydrocele in a young child may not — which is why you never interpret one sign in isolation. The cough impulse and the can-get-above sign together are what protect you from calling a hernia a hydrocele, and the ultrasound is what protects you from missing a tumour behind the fluid.[1]

Processus vaginalis embryology — the key that unlocks every subtype

Hydroceles are classified by the patency of the processus vaginalis — one embryology explains every anatomical subtype. The testis develops in the retroperitoneum near the kidney and descends through the inguinal canal in the seventh to eighth month of gestation, carrying a finger of peritoneum — the processus vaginalis — ahead of it. After descent, the canal portion obliterates and the portion around the testis persists as the tunica vaginalis.[1][6]

The fate of the processus vaginalis is the four-way fork every candidate must reproduce:[1]

• Complete obliteration (normal) — only the tunica vaginalis remains; no peritoneal communication.
• Complete patency — peritoneal fluid drains freely into the scrotum: a congenital (communicating) hydrocele. The same open channel can admit bowel as an indirect inguinal hernia, which is why the two share a common operation in children.
• Obliteration at the internal ring only — fluid tracks down but cannot return: an infantile hydrocele (a closed sac extending to the deep ring).
• Segmental obliteration with a locule left along the cord — an encysted hydrocele of the cord.[1]

The processus vaginalis fails to obliterate in roughly 20 percent of adults on post-mortem study, which is why some adult hydroceles are actually communicating and why a hernia can appear de novo later in life.[1]

[1]

By aetiology, the same hydrocele sorts into three buckets the examiner will ask for:[1]

• Primary (idiopathic) — an imbalance of secretion and absorption by the tunica vaginalis with no cause found; the commonest adult type.
• Secondary — reactive hydrocele from an identifiable cause: epididymo-orchitis, testicular tumour, trauma, post-surgical lymphatic disruption (varicocelectomy, hernia repair, renal transplant), irradiation, or tuberculosis. Usually small-to-moderate; find and treat the cause.[2][5]
• Filarial — endemic in the tropics; Wuchereria bancrofti lymphatic obstruction produces a chylocele (milky, lymph-rich fluid). A major public-health problem in parts of India, Africa, and South-East Asia.[1][3]

Two cord terms examiners use to catch you out:[1]

• Funicular hydrocele — fluid along the spermatic cord in a sac patent at the internal ring but closed distally above the testis; the testicular tunica is separate. It lies above and separate from the testis, transilluminates, and mimics a cord swelling.
• Hydrocele of the cord — a loculated collection along a segment of unobliterated processus vaginalis, closed both above and below; a transilluminable swelling along the line of the cord that is separate from the testis.[1]

How common, and who — the numbers that frame the topic

Hydrocele is common worldwide, but the aetiology and demographics shift sharply with geography. Know the three populations.[1][4]

• Congenital hydrocele — detectable in about 6 percent of newborn males because the processus is still patent at birth. Over 90 percent close spontaneously by 12 to 24 months. Persistence after age 2 warrants surgical referral.[6]
• Adult primary hydrocele — typically the fourth to sixth decades, unilateral in about two-thirds, right-sided slightly more often than left, and mostly idiopathic.
• Filarial hydrocele — the dominant form in the tropics. The Global Programme to Eliminate Lymphatic Filariasis estimated about 19 million prevalent hydrocele cases worldwide, the great majority from Wuchereria bancrofti in sub-Saharan Africa, India, South-East Asia, and the Pacific. In endemic Indian states it is the most common surgical condition in adult males.[1][4]

[1]

Risk factors cluster around the same three populations:[1]

• Infancy — a patent processus vaginalis is a normal developmental variant that usually closes.
• Endemic filarial exposure — residence in or travel to a filariasis zone; repeated mosquito bites (Culex, Anopheles, Aedes).
• Scrotal trauma or surgery — injury to the tunica or lymphatics after varicocelectomy, inguinal hernia repair, or renal transplant.
• Epididymo-orchitis or testicular tumour — inflammatory or neoplastic transudation produces a secondary hydrocele.
• Nephrotic syndrome or heart failure — a rare cause of bilateral hydroceles through anasarca in severe fluid overload.[1]

Why the fluid builds — secretion versus absorption, and the filarial twist

The healthy tunica vaginalis secretes and reabsorbs serous fluid in equilibrium; break that balance and a hydrocele forms. Primary idiopathic hydrocele is a subtle transport imbalance whose trigger is usually unidentifiable; secondary hydrocele is driven by excess production from inflammation or impaired absorption from lymphatic obstruction.[5]

Filarial hydrocele is a different disease — chronic lymphatic obstruction, not a fluid-balance problem. Adult Wuchereria bancrofti worms live for years in human lymphatics and nodes, causing lymphangitis, lymphatic dilation, and progressive obstruction of the scrotal, inguinal, and retroperitoneal lymphatics. The fluid turns milky and lymph-rich (chylocele) and may carry microfilariae; repeated inflammatory episodes thicken and fibrose the tunica and eventually produce scrotal elephantiasis. That is why surgery alone, without anti-parasitic treatment, invites recurrence.[1][3]

Any insult to the tunica can produce a secondary hydrocele. The list the examiner wants: epididymo-orchitis, testicular torsion (the reactive hydrocele is a classic trap), testicular tumour — up to 10 percent of testicular tumours present with a secondary hydrocele — trauma, post-surgical lymphatic disruption, and tuberculosis. The fluid is usually small-to-moderate; the priority is the cause, not the hydrocele.[2][5]

Three presentations that are NOT a simple hydrocele

[1]

Atypical scenarios to flag at the bedside: a rapidly enlarging hydrocele in an older man (underlying malignancy until proven otherwise); bilateral huge hydroceles in an adult (filariasis or anasarca from nephrotic syndrome or heart failure); a tense hydrocele after scrotal trauma (haematocele — blood-stained, does not transilluminate); and a secondary hydrocele with fever (epididymo-orchitis or pyocele).[1]

The differential of painless scrotal swelling — exclude the killers first

The differential of painless scrotal swelling is short, but every member must be confidently separated because the management diverges sharply. This table is the cornerstone of the scrotal-swelling SAQ.[2][1]

[1]

The two-minute scrotal examination — look for the four signs

A focused scrotal examination, in under two minutes, confirms the diagnosis and excludes the dangerous mimics. Stand the patient up first, then lie him down.[1]

Inspection — size, symmetry, and overlying skin (erythema implies infection; blue discoloration implies torsion); whether the swelling extends into the groin; and, in endemic areas, look for elephantiasis of the scrotum or limbs.[1]

Palpation — the four signs plus the contralateral side:[1]

• Can you get above it? Yes equals scrotal; no equals inguinal hernia.
• Feel the testis separately — in a vaginal hydrocele you cannot; palpate the epididymis above and behind (an epididymal cyst lives here).
• Cough impulse — two fingers over the swelling; vaginal hydrocele none, communicating hydrocele or hernia a palpable expansile impulse.
• Reducibility — gentle sustained pressure reduces a communicating hydrocele slowly with a gurgling feel; a vaginal hydrocele cannot be reduced.
• Transillumination — darken the room, pen-torch against the swelling; diffuse red glow equals fluid, no transmission equals solid (tumour, hernia, haematocele).
• Examine the contralateral side and do a general examination for lymphoedema, groin nodes, and signs of systemic disease (heart failure, nephrotic syndrome).[1]

Transillumination done right: use a cold-light source or pen-torch in a darkened room, placed flat against the posterior aspect of the swelling so light passes through the fluid-filled sac and testis. A clear hydrocele gives a homogeneous red glow. Interpret it alongside the other signs — a chylocele or haematocele transilluminates poorly, a fluid-filled hernia can transilluminate, and a tense hydrocele in a young child may not.[1]

Investigations — ultrasound first, and only then the knife

Hydrocele is essentially a clinical diagnosis; imaging and bloods exist to confirm the atypical case, exclude a tumour, and chase a secondary cause. A straightforward primary hydrocele needs no bloods.[2][5]

A scrotal ultrasound is mandatory in any adult hydrocele before surgery, because it visualises the testis the fluid is hiding. It confirms:[1]

• An anechoic fluid collection around the testis, testis displaced posteriorly (classic vaginal hydrocele).
• The testicular parenchyma — excluding a solid intratesticular tumour that would otherwise be missed. This is the critical safety step.
• Internal echoes, septations, or a solid component — suggests haematocele, pyocele, or tumour.
• Doppler blood flow — excludes torsion when the presentation is acute.[2]

The classic trap: up to 10 percent of testicular tumours present behind a reactive hydrocele. Ultrasound before any surgery is the one step that stops you operating on a hydrocele that is actually a germ-cell tumour. In infants with a clear, transilluminant, reducing swelling, ultrasound is not routinely required unless the diagnosis is in doubt.[6]

Bloods, only when indicated:[1]

• AFP, beta-hCG, and LDH — if a tumour is suspected (solid mass on ultrasound, or a non-transilluminant or rapidly enlarging hydrocele). Elevation mandates urgent urology referral and staging CT.
• Full blood count and CRP — if epididymo-orchitis or pyocele is suspected (leucocytosis, raised inflammatory markers).
• Filarial antigen test and nocturnal peripheral blood smear for microfilariae — in endemic areas or with a chylocele or elephantiasis.[1]

Diagnostic aspiration is rarely needed and reserved for an atypical collection when ultrasound is inconclusive — to distinguish a chylocele (milky) or pyocele (purulent) from a simple hydrocele. The fluid of a simple hydrocele is clear and straw-coloured. Therapeutic aspiration is not a treatment (see Management).[7]

Management — first, separate the emergencies from the elective

A hydrocele itself is not an emergency — the resuscitation question arises only when the diagnosis is wrong. These four mimics need theatre or urgent imaging, not elective clinic:[1]

• Strangulated inguinal hernia misdiagnosed as hydrocele — a scrotal swelling that is tender, irreducible, with vomiting, abdominal distension, and systemic upset. Resuscitate with intravenous fluids, analgesia, broad-spectrum antibiotics, and emergency surgery.
• Testicular torsion — sudden painful swelling in a young male with an absent cremasteric reflex is torsion regardless of any associated fluid. Immediate surgical exploration within the 6-hour salvage window; do not wait for imaging.
• Pyocele — fever, severe tenderness, systemic upset. Urgent ultrasound, intravenous antibiotics, and surgical drainage.
• Ruptured hydrocele or haematocele after trauma — urgent ultrasound for testicular integrity; surgical exploration if the tunica albuginea is torn.[1]

The classic trap: calling torsion a hydrocele. Hydrocele is painless; torsion is excruciating. Mislabelling costs the testis. Once the emergencies are excluded, the rest of hydrocele management is elective and structured by age and aetiology.[1]

Congenital hydrocele — observe until age 2, then herniotomy

In children the rule is simple: reassure, observe, and only operate if it persists past age 2. The operation is on the processus vaginalis, not the tunica.[6]

[6]

The key principle in children: the operation is on the processus vaginalis (high ligation at the internal ring via an inguinal incision), not on the tunica itself. It is the same operation as for an indirect inguinal hernia in a child, because the two share a common anatomical defect.[6]

The classic trap: aspirating an infant's hydrocele. The processus is open, so it recurs within days, and you risk introducing a pyocele. Observe until age 2.[6]

Adult hydrocele — ultrasound before you ever cut

Three open surgical procedures dominate adult practice; all are curative with recurrence under 5 percent, and choice turns on the thickness of the sac. Always ultrasound first to exclude a tumour hiding behind the fluid.[1][5]

[1]

One-line discriminator beneath the face-off: thin sac to Jaboulay or Lord, thick fibrous sac to excision; minimise dissection wherever you can to keep the haematoma rate down.[5]

Aspiration is not treatment — the Shakiba 9.43 number

Aspiration alone always recurs and risks introducing a pyocele — it is not a treatment. Aspiration followed by sclerotherapy (instilling phenol, tetracycline, ethanolamine oleate, or polidocanol to obliterate the sac) is an alternative only for the medically unfit patient who cannot tolerate surgery, or for those who decline an operation.[7]

[7]

The number to carry into the viva: recurrence risk ratio 9.43 for sclerotherapy versus surgery. Surgery is first-line where feasible; sclerotherapy is second-line for the unfit.[7]

Filarial chylocele — the tropical hydrocele (DEC plus doxycycline)

In filarial hydrocele the surgery is the same but the fluid disease is different, so you must add anti-parasitic therapy or it recurs. The sac is usually thickened and fibrous, so excision is often preferred over plication or eversion.[1]

The two-drug bundle, alongside surgery:[1][3]

• Diethylcarbamazine (DEC) 6 mg/kg orally for 12 days — the standard anti-filarial regimen.
• Doxycycline 100 to 200 mg daily for 4 to 6 weeks — targets the Wolbachia endosymbiont, reducing worm burden and inflammation.
• In India's Mass Drug Administration programme, DEC plus albendazole is given annually to endemic districts to interrupt transmission.[3]

The classic trap: operating on a filarial hydrocele without DEC and doxycycline. You have fixed the sac but left the worms and the lymphatic disease — recurrence and progression to elephantiasis follow. Surgery plus medical therapy is the WHO morbidity-management standard.[1][4]

Secondary hydrocele — treat the cause, not the fluid

Treat the underlying cause and the secondary hydrocele usually resolves. Antibiotics for epididymo-orchitis; treat torsion or trauma surgically; excise a testicular tumour (radical inguinal orchidectomy with staging). Surgery on the hydrocele itself is reserved for large, persistent collections.[2]

The subtypes that bite

These subtypes appear in vivas precisely because juniors confuse them. Name each by its relationship to the processus vaginalis.[1]

• Hydrocele of the cord (funicular) — fluid along the spermatic cord in a segment of unobliterated processus vaginalis; a transilluminable swelling along the line of the cord, separate from and above the testis. It mimics an inguinal hernia but has no cough impulse (the sac is closed) and you can often get above it. Treatment is surgical excision.[1]
• Encysted hydrocele of the cord — a loculated collection trapped within a short segment of processus vaginalis, closed above and below; a discrete, mobile, transilluminant scrotal or inguinal lump separate from the testis. Excision is curative.
• Infantile hydrocele — processus closed at the internal ring but patent down to the scrotum; fluid extends to the deep ring but does not communicate with the peritoneum. Does not reduce, no cough impulse; most resolve by age 2.[6]
• Filarial hydrocele or chylocele — milky, lymph-rich fluid in an endemic-area patient, often with scrotal elephantiasis and limb lymphoedema. Surgery plus DEC and doxycycline. A major cause of disability in the tropics.[1][4]
• Post-surgical hydrocele — after varicocelectomy, inguinal hernia repair, or renal transplantation from lymphatic disruption. Often resolves spontaneously; persistence warrants ultrasound and possible surgery.[5]
• Hydrocele of the canal of Nuck — the female analogue (a patent processus vaginalis along the round ligament) presents as a swelling in the inguinal canal or labium majus; management parallels the male condition.[1]

How hydrocele patients come to harm — the preventable list

These are the recurring, preventable harms — name every one in the viva:[1]

• Calling torsion a hydrocele and losing the testis — hydrocele is painless; torsion is excruciating. The 6-hour window is unforgiving.
• Missing a testicular tumour behind the fluid — every adult hydrocele needs an ultrasound before surgery; up to 10 percent of tumours hide behind one.
• Aspirating an infant's hydrocele — it recurs immediately and risks a pyocele. Observe until age 2.
• Misdiagnosing an incarcerated or strangulated hernia as a hydrocele — failing to test whether you can get above it, or for a cough impulse. A strangulated hernia is a surgical emergency; a hydrocele is not.
• Operating on a filarial hydrocele without DEC — recurrence and progression of lymphatic disease follow.
• Testicular atrophy from a long-standing, large, bilateral hydrocele — chronic pressure on the testicular vessels; bilateral disease may impair fertility.[1]

Complications — of the disease and of the surgery

The disease itself can harm the testis and rarely the sac. Long-standing large hydroceles cause testicular atrophy (bilateral disease may impair fertility); infection or pyocele makes the sac tender, hot, and non-transilluminant; haematocele follows trauma and may rupture the testis; rare rupture and calcification of longstanding sacs occur; and malignant mesothelioma of the tunica vaginalis is a very rare but recognised association — a nodular sac, bloody fluid, or persistent recurrence after surgery should raise suspicion.[1][5]

Surgery has its own complications, led by the scrotal haematoma:[5]

• Haematoma — the commonest surgical complication; reduced by meticulous haemostasis and the Lord technique (less dissection). A scrotal haematoma can be large and painful and may need drainage.
• Recurrence — under 5 percent for all three open procedures; higher for aspiration-sclerotherapy.
• Infection — wound or scrotal sepsis.
• Injury to the spermatic cord — the vas deferens or testicular vessels lie within the cord; careless dissection risks ischaemic atrophy or infertility, particularly in eversion and excision.
• Fistula — rare; persistent leakage of fluid.
• Chronic pain — a small proportion report chronic scrotal discomfort postoperatively.[5]

Prognosis, disposition, and special populations

Prognosis after surgical treatment is excellent. Recurrence is under 5 percent for all three open procedures; testicular function is preserved in the vast majority. Most patients are discharged the same day or after an overnight stay and return to normal activity within 2 to 4 weeks, avoiding heavy lifting for 6 weeks.[1]

Congenital hydrocele resolves by age 2 in over 90 percent; those needing herniotomy have an excellent outcome with minimal recurrence.[6]

Filarial hydrocele has a good surgical outcome but needs ongoing anti-filarial therapy (DEC, doxycycline) to prevent recurrence and progression to lymphoedema and elephantiasis. Surgical camps in endemic districts deliver hydrocele surgery as part of the WHO morbidity-management strategy.[1][4]

Secondary hydrocele takes the prognosis of its cause: a testicular tumour has its own staging and treatment algorithm; epididymo-orchitis usually settles with antibiotics and the hydrocele resolves.[1]

Disposition: primary and congenital hydroceles are managed electively in the outpatient setting with day-case surgery. Admission is reserved for complications (pyocele, haematocele, strangulated hernia, torsion) or extensive filarial surgery.[1]

Special populations to name in the viva:[1]

• Infants and children — most congenital hydroceles resolve by age 2. Do not aspirate. Observe with periodic review; if persistent at age 2, clearly communicating, or associated with a hernia, perform herniotomy (inguinal approach, high ligation at the internal ring).[6]
• Elderly men — ultrasound before any surgery to exclude an underlying tumour. Large longstanding hydroceles may cause atrophy; comorbidity may favour aspiration-sclerotherapy over surgery.[5]
• Filarial-endemic populations — surgery plus anti-parasitic therapy, embedded in the national MDA programme (India: annual DEC plus albendazole). Hydrocele surgery is among the most cost-effective surgical interventions globally.[1][4]
• Females (canal of Nuck) — the rare female equivalent presents as an inguinal or labial swelling; management parallels the male condition.
• Post-renal-transplant patients — hydrocele and lymphocele from lymphatic disruption; ultrasound and conservative management first, surgery for persistent collections.[5]

Regional deltas — one framework, resource-dependent choices

The diagnostic and management framework (clinical signs, ultrasound before surgery, open eversion or plication) is globally consistent; what shifts is the sclerotherapy habit and the filarial burden.[1][5]

[1]

India-specific filarial burden: India bears a large share of global filarial hydrocele. The National Centre for Disease Control (NCDC) runs the Mass Drug Administration (MDA) programme — annual DEC plus albendazole to endemic districts — alongside hydrocele surgical camps. Bihar, Uttar Pradesh, Jharkhand, West Bengal, and Odisha are the highest-burden states. Hydrocelectomy in this setting is one of the most cost-effective surgical interventions in global health.[1][4]

[7]

The mantra, and the mnemonics

[1] [1]

The mantra: can get above it, transilluminates, no cough impulse — and ultrasound before you ever cut.[1][2]

[1]

Ward-round test — three stems, thirty seconds each

Stem 1 — the one-year-old with a scrotal swelling that changes size (answer)

A one-year-old boy has a soft, transilluminant scrotal swelling that is larger in the evening when he cries and smaller in the morning. What is the diagnosis and the management? Model: This is a congenital (communicating) hydrocele due to a patent processus vaginalis — the diurnal size change confirms communication with the peritoneum, as peritoneal fluid drains down the processus when intra-abdominal pressure rises. Management is reassure and observe — over 90 percent close spontaneously by age 2. Do not aspirate. If still present after age 2, refer for herniotomy (high ligation of the processus vaginalis at the internal ring via an inguinal incision).[6]

Stem 2 — the 45-year-old with a tense, non-tender, transilluminant swelling (answer)

A 45-year-old man has a large, tense, non-tender left scrotal swelling that transilluminates; the testis cannot be felt separately. What is the next step before surgery? Model: Ultrasound scrotum to evaluate the underlying testis and exclude a tumour — up to 10 percent of testicular tumours present with a reactive hydrocele. If ultrasound is suspicious (solid intratesticular lesion), check AFP, beta-hCG, and LDH and refer urgently to urology. If ultrasound confirms a simple hydrocele with a normal testis, proceed to elective surgery — Lord plication or Jaboulay eversion for a thin sac, excision if the sac is thick.[2]

Stem 3 — the 50-year-old from an endemic district with a milky hydrocele (answer)

A 50-year-old man from a filarial-endemic district has a large scrotal swelling containing milky fluid, with limb lymphoedema. After surgery, what must you add, and why? Model: This is a filarial chylocele from Wuchereria bancrofti lymphatic obstruction. After surgical excision of the thickened fibrous sac, add diethylcarbamazine (DEC) 6 mg/kg orally for 12 days plus doxycycline 100 to 200 mg daily for 4 to 6 weeks (targeting the Wolbachia endosymbiont). Surgery alone leaves the worms and the lymphatic disease — recurrence and progression to elephantiasis follow. In India this sits within the annual MDA programme of DEC plus albendazole.[3]

References

1. [1]Rajasekaram S, Anuradha R, Manokaran G, Bethunaickan R. An overview of lymphatic filariasis lymphedema Lymphology, 2017.PMID 30248721
2. [2]Gratzke C, Seitz M, Zaak D, Reich O, Schlenker B, Stief CG. [Painless enlargement of the scrotum] MMW Fortschr Med, 2006.PMID 16875378
3. [3]Goldin J, Juergens AL. Filariasis 2026.PMID 32310472
4. [4]Beard JH, Ohene-Yeboah M, devries CR, et al. Hernia and Hydrocele 2015.PMID 26741001
5. [5]Filmar S, Gross AJ, Hook S, Rosenbaum CM, Netsch C, Becker B. [Hydrocele] Urologie, 2024.PMID 38780784
6. [6]Patoulias I, Koutsogiannis E, Panopoulos I, Michou P, Feidantsis T, Patoulias D. Hydrocele in Pediatric Population Acta Medica (Hradec Kralove), 2020.PMID 32771069
7. [7]Shakiba B, Heidari K, Afshar K, Faegh A, Salehi-Pourmehr H. Aspiration and sclerotherapy versus hydrocelectomy for treating hydroceles: a systematic review and meta-analyses Surg Endosc, 2023.PMID 37277518