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Clinical presentation

A hydrocoele presents as a painless swelling, confined to the scrotal cavity. Though there may be an occasional dragging discomfort related, most men seek medical advice on account of their apprehension regarding the nature and size of the swelling. Physical examination reveals the features of a smooth, symmetrical cystic swelling, filling a varying but often greater part of the scrotum. The classic physical sign is the inability to feel the testis separate from the swelling. Though the cystic and, hence, benign nature of a hydrocoele can be confirmed by way of shining a light through the scrotal wall so as to transilluminate the swelling, a more effective means of confirming the diagnosis of a benign hydrocoele and, within that, demonstrating the normality of the underlying testicle is to perform a scrotal ultrasound scan. However, such is the straightforward clinical presentation of a hydrocoele that even this simple investigation is only required in situations where there are equivocal physical findings or suspicious clinical circumstances, such as youth.